NATIONAL HEALTH INSURANCE AUTHORITY 2013 …nhis.gov.gh/files/2013 Annual Report-Final ver...
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Transcript of NATIONAL HEALTH INSURANCE AUTHORITY 2013 …nhis.gov.gh/files/2013 Annual Report-Final ver...
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NATIONAL HEALTH INSURANCE AUTHORITY
2013 ANNUAL REPORT
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TABLE OF CONTENT LIST OF FIGURES ............................................................................................................................................................. iv
LIST OF TABLES ............................................................................................................................................................... iv
VISION, MISSION AND CORE VALUES .................................................................................................................... v
BOARD MEMBERS .......................................................................................................................................................... vi
MANAGEMENT TEAM ................................................................................................................................................ viii
PROFILE OF CHIEF EXECUTIVES................................................................................................................................ x
PROFILE OF DIRECTORS ........................................................................................................................................... xiii
CHAIRMAN’S ACKNOWLEDGEMENT ................................................................................................................. xix
CHIEF EXECUTIVE’S REPORT .................................................................................................................................... xx
1.0 INTRODUCTION ..................................................................................................................................................... 1
1.1 GOVERNANCE .............................................................................................................................................. 1
1.2 MANAGEMENT .............................................................................................................................................. 1
1.3 NHIS VALUE CHAIN .................................................................................................................................... 1
1.4 CORPORATE GOALS ................................................................................................................................. 2
1.5 CORPORATE OBJECTIVES FOR 2011-2014 ......................................................................2
2.0 OPERATIONAL AND FINANCIAL REPORTS ................................................................................................. 4
2.1 Operational Report ........................................................................................................................................ 4
2.2 Creating geographical access to health care through credentialing of health care facilities ............. 8
3.0 CLAIMS MANAGEMENT ...................................................................................................................................... 13
3.1 Out-patient Utilisation ................................................................................................................................. 13
3.2 In-patient Utilisation ..................................................................................................................................... 14
4.0 HEALTH EQUITY .................................................................................................................................................... 15
4.1 Equity in health insurance coverage (enrolment) ...................................................................................... 15
4.2 Access by the poor and vulnerable to healthcare services ..................................................................... 16
4.3 Protection of the poor and vulnerable against financial risk ................................................................... 17
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4.4 Premium (contributions) and National Health Insurance Levy (NHIL) ............................................... 17
4.5 Exemption strategy ........................................................................................................................................... 17
5.0 GOVERNANCE SYSTEMS ..................................................................................................................................... 19
5.1 Effect of the implementation of the NHIS on the nation......................................................................... 19
5.2 Training and Development .............................................................................................................................. 20
5.2 Management Information System/Information Communication Technology ..................................... 20
5.2.1 Biometric Membership System ................................................................................................................... 20
5.2.2 Data Centre Upgrade ................................................................................................................................... 21
5.3 Oversight of Private Health Insurance Schemes (PHIS) ........................................................................... 21
5.4 Organisational Reforms in 2013 .................................................................................................................... 22
5.4.1 The Structure of the Organisation under Act 650 ................................................................................ 22
5.4.2 The Structure of the Organisation under Act 852 ................................................................................ 22
6.0 COMMUNICATION AND STAKEHOLDER ENGAGEMENTS .................................................................. 25
6.1 Study tour ........................................................................................................................................................... 26
6.2 Collaboration with Development Partners ................................................................................................. 26
6.3 Policy consulting between NHIA and KOFIH ............................................................................................ 29
6.4 Policy Fair ............................................................................................................................................................ 29
6.5 Media Interactions ............................................................................................................................................. 29
6.6 Brand Enhancement .......................................................................................................................................... 30
6.7 NHIS@10 Commemoration .......................................................................................................................... 30
6.7.1 NHIS@10 International Conference ........................................................................................................ 30
6.7.2 NHIS@10 Quiz Competition ..................................................................................................................... 33
6.7.3 NHIS@10 Special Thanksgiving and Awards Service ............................................................................ 33
APPENDIX 1: TRAINING PROGRAMMES ORGANISED IN 2013 ................................................................... 38
APPENDIX 2: UNAUDITED FINANCIAL STATEMENT ..................................................................................... 39
APPENDIX 3: QUANTITATIVE AND QUALITATIVE ASSESSMENT OF TARGETS FOR THE YEAR
2013 .................................................................................................................................................................................... 50
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LIST OF FIGURES
Figure 1: NHIS Value Chain .................................................................................................................................................................. 2
Figure 2: NHIS Subscribers by Category as at December 2013 ................................................................................................. 5
Figure 3: Indigent enrolment from 2009-2013 Indigent enrolment from 2009-2013............................................................ 8
Figure 4: Accredited Facilities by Region .......................................................................................................................................... 9
Figure 5: Accredited Facilities by Ownership ................................................................................................................................ 10
Figure 6: Accredited Facilities by Grade ......................................................................................................................................... 10
Figure 7: Accredited Facilities by Type ............................................................................................................................................ 10
Figure 8: Investment Portfolios Returns ......................................................................................................................................... 12
Figure 9: Out-patient Utilisation Trend in Millions (2009-2013) .............................................................................................. 13
Figure 10: In-patient Utilization Trend in Millions (2009-2013) ................................................................................................ 14
Figure 11: Claims Payment Trend 2009-2013 (GH¢ Millions) ................................................................................................... 14
LIST OF TABLES
Table 1: Active Membership (2013) ............................................................................................................. 4
Table 2: Comparison of new registrations and renewals (2012/2013) ................................................ 5
Table 3: Registration under Free Maternal Care ....................................................................................... 6
Table 4: Indigent enrolment by year ............................................................................................................ 7
Table 5: Population and Enrolment Distribution, 2013 ........................................................................ 15
Table 6: Distribution of credentialed healthcare providers, 2013 ...................................................... 16
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VISION, MISSION AND CORE VALUES
VISION
To be a model of a sustainable, progressive and equitable social health insurance scheme in Africa
and beyond.
MISSION
To provide financial risk protection against the cost of quality basic health care for all residents in
Ghana, and to delight our subscribers and stakeholders with an enthusiastic, motivated, and
empathetic professional staff who share the values of accountability in partnership with all
stakeholders.
CORE VALUES
Integrity
Accountability
Empathy
Responsiveness
Innovation
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BOARD MEMBERS
1 Dr. Steve Ahiawordor Ag. Chairman
2 Mr Sylvester A. Mensah Chief Executive
3 Mr Kofi Asamoah Member
4 Dr. Hetty Asare Member
5 Dr. Stephen Ayidiya Member
6 Mr Samuel Akwei Member
7 Mrs Czarina Baeta Ribeiro Member
8 Dr. Mercy Bannerman Member
9 Dr. Edward Abbah-Foli Member
10 Hon. Hajia Laadi Ayii Ayamba Member
11 Mr Anthony Dzadzra Member
12 Mrs Nyamekeh Kyiamah Member (Resigned in Dec. 2013)
13 Ms Diana O. Ahene Board Secretary
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BOARD SECRETARY : MS DIANA O. AHENE
REGISTERED OFFICE : NO. 36-6 AVENUE, OPPOSITE AU
SUITE, RIDGE INDUSTRIAL AREA,
ACCRA
AUDITORS : ERNST AND YOUNG,
CHARTERED ACCOUNTANTS
BANKERS : GHANA COMMERCIAL BANK,
ECOBANK GHANA LTD
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MANAGEMENT TEAM
Sylvester A. Mensah Chief Executive
Nathaniel Otoo Deputy Chief Executive, Operations
Edward Amissah Nunoo Deputy Chief Executive, Admin & HR
Alex Odoi Nartey Deputy Chief Executive, Finance & Investment
O. B. Acheampong Director, Research & Development
Dr. Gustav Cruickshank Chief Internal Auditor
Dr. Lydia Dsane-Selby Director, Claims
Ben Kusi Director, MPRO
Anthony Gingong Director, Quality Assurance
Perry Nelson Director, Management Information Systems
Winfred Agbeibor Director, Corporate Affairs
Ben Yankah Chief Actuary
Diana O. Ahene Board Secretary/Head, Private Health Insurance Scheme
Emmanuel Fianko Director, Procurement & Projects
Ahmed Imoro Ag. Director, Finance
Mary Owusu Ag. Director, Admin & HR
Francis-Xavier Andoh-Adjei Deputy Director, PME/IR
Sam Buabasah Deputy Director, Corporate Affairs
Dr. Francis Asenso-Boadi Mensah Deputy Director, Research & Development
Adelaide Bunatal Deputy Director, MPRO
Aimee Yuori Deputy Director, Legal
Rudolf Zimmermann Deputy Director, Finance
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Vitus G. Kaleo-Bioh Deputy Director, Business Systems
Dr. Nii Anang Adjetey Deputy Director, Corporate Affairs
Collins Danso Akuamoah Deputy Director, MPRO
Richard Attiah Deputy Director, HR
Raphael Segkpeb Deputy Director, Admin
Washington Komla Darke Deputy Director, Fund & Investment
Angela D. Auch Deputy Director, Training & Development
William Omane Adjekum Deputy Director, Cape Coast CPC
Nicholas Osei Afram Deputy Director, Claims Vetting Operations
Stephen Bewong Deputy Director, Business Systems
Vivian Addo-Cobbiah Deputy Director, Provider Services
Appiah-Sarfo Kantanka Deputy Director, Kumasi CPC
Zankawah Baba Sadique K Deputy Director, Tamale CPC
George Omaboe Deputy Chief Internal Auditor - Assurance
Prince Appiah Debrah Deputy Chief Internal Auditor - Advisory & Risk Management
Aimee Yuori Deputy Director, Legal
Theresa Talata Kunlie Deputy Director, Legal
Thomas Adoboe Deputy Director, ICT Business Infrastructure
Constance Addo-Quaye Deputy Director, Quality Assurance
Ismail Osei Deputy Director, Quality Assurance
Seidu Abudu Sampson Deputy Director, Eastern Region
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PROFILE OF CHIEF EXECUTIVES
SYLVESTER A. MENSAH: CHIEF EXECUTIVE
Sylvester A. Mensah, Chief Executive of the National Health
Insurance Authority (NHIA) has work experience spanning 25
years in various sectors including Public Services, the Private
Sector, Banking, Politics, and Academia. His experience
portfolio includes:
Extensive knowledge of finance, banking, fund management & investment.
Experience in legislation, governance & policy making at the highest level.
Expertise in managing critical social mobilization programs.
Accomplished academic career in the areas of strategic management and business
communication.
Comprehensive experience in the management of professional teams and individuals.
Proficiency in technical and non-technical communication; effective in articulating
information to various audiences.
His capacities as a lecturer, banker, politician, social worker, author and social health insurance
technocrat, with expertise in strategic management and finance, underscore his professional and
occupational versatility demonstrated throughout his working life. This diversity and breadth of
occupational experiences is undergirded by academic qualifications earned in institutions in Ghana
(Africa), Europe and the United States.
Sylvester Mensah holds an MBA in Finance from the University of Leicester in the UK, a BSc in
Administration from the University of Ghana, Legon, a Diploma in Public Administration from
the University of Ghana, and a Diploma in Political Economy from Cotbus Political College,
Germany. He also holds a Diploma in Global Health Leadership from the University of California
School of Public Health and Barcelona Graduate School of Economics, and a number of
Certificates from Harvard University School of Public Health.
As a Parliamentarian, Honourable Sylvester Mensah served a full term as a Member of Parliament
for the Dadekotopon constituency in the Greater Accra Region of Ghana between 1997 and 2001,
during which he served on Parliamentary Select Committees on Lands & Forestry, Employment
and Social Welfare, Youth & Sports, and the Appointments Committee.
In his capacity as the Chief Executive of the NHIA, he has initiated far-reaching organizational
restructuring, charting out a new strategic direction, and instituting reforms and initiatives such as
clinical auditing which are driving cost-efficiency and other improvements in the National Health
Insurance Scheme (NHIS). In his tenure at the helm, the NHIS won the coveted UN award for
Excellence, Leadership and Innovation. Globally, the profile of the NHIS continues to rise as an
international hub of knowledge and experience sharing.
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Prior to his appointment as the Chief Executive of the NHIA, Mr. Mensah was the Head of Public
Sector Banking at the Intercontinental Bank (GH) Ltd, a full time Lecturer at the Institute of
Professional Studies (Ghana), and an Adjunct Lecturer with the Central University Graduate
School. He has worked in the Civil and Public Services as a District Co-ordinator of the then
National Mobilization Programme of Ghana, rising through the ranks to the office of Greater Accra
Regional Director.
Mr Mensah is the author of the book entitled “In the shadows of Politics: Reflections from my
mirror” and many other publications.
NATHANIEL OTOO: DEPUTY CHIEF EXECUTIVE, OPERATIONS
Nathaniel Otoo is the Deputy Chief Executive (Operations) of the NHIA.
Prior to his appointment to this position in 2013, he was the Director of
Administration & General Counsel, a position he held for seven years. In
this role he anchored major legal and structural reforms within the NHIS.
Nathaniel has over 24 years of work experience spanning both the public
and private sectors. He worked as Corporate Secretary at the Social Security
& National Insurance Trust, Project Coordinator at Promasidor Ghana
Limited and Export Development Officer at the Ghana Export Promotion
Council. He has also held several consultancies.
Mr. Otoo completed his Professional Law studies in 1988 after obtaining a Bachelor’s degree in
Law (LLB) from the University of Ghana, and subsequently pursued a Master of Arts Degree in
International Relations at the International University of Japan, where he specialized in
International Management. Under the auspices of the Carl Duisberg Gesellschaft e.V., he
undertook a professional training in Marketing and Management in Germany from 1995 to 1997.
During this period he trained in policy analysis at Libertas Europäisches Institut GmbH.
Nathaniel has participated in various health leadership courses and served as speaker/resource
person at various local and international health forums. He is currently the Convenor of the Joint
Learning Network, a global UHC peer learning network with membership across countries in
Africa and Asia.
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EDWARD AMISSAH-NUNOO: DEPUTY CHIEF EXECUTIVE, ADMIN & HR
For 27 years, Edward has been pursuing a career in a broad spectrum
of activities spanning Security, Public Service, Academia and the
Private Sector.
He was in Senior Management position in the Ghana Customs Excise
and Preventive Service and a Law Lecturer in the Ghana Institute of
Management and Public Administration (GIMPA).
He is a Lawyer by profession, a security professional by training and
a crisis management expert. He was a visiting lecturer in the Ghana
Police College.
Prior to his appointment as Deputy Chief Executive, Edward was a Private Legal Practitioner and
a National Security Consultant in the National Security Secretariat. He trained variously both
locally and internationally including the US Department for Homeland Security.
He holds a Masters Degree from the Legon Centre for International Affairs (LECIA), University
of Ghana, where he also obtained his first degree.
A seasoned Administrator with exposure to emerging trends in Administration and International
best practices, Edward joins the Executive Management with a wide array of expertise.
ALEX NARTEY: DEPUTY CHIEF EXECUTIVE, FINANCE & INVESTMENT
Mr. Alex Odoi Nartey, DCE (Finance & Investment) joined the NHIA
with over 25 years of relevant experience in the public service as a
Chartered Accountant. He is also a Project Management Expert with
considerable experience working in other parts of Africa. Mr. Nartey
worked as Chief Accountant of the Ministry of Health in Ghana and
later as the Director of Finance for the Ghana Health Service (GHS).
As an Associate Consultant to PwC and later Ernst & Young, Mr. Nartey served as Senior
International Financial Controller in Liberia’s Ministry of Health & Social Welfare and later as
the Financial Advisor to the same Ministry. He has been a lead Technical Designer and
Implementer of Financial Systems with capacity building and financial decentralization in Ghana,
Liberia and Sierra Leone. He has been involved in many reforms in financial management for the
Government of Ghana (GoG) and has managed grants from various donors.
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PROFILE OF DIRECTORS
OSEI BOATENG ACHEAMPONG: DIRECTOR, RESEARCH AND
DEVELOPMENT
As Director of Research and Development, Mr. Acheampong oversees the
development of systems to facilitate the implementation of the NHIS and
also monitors the operations of such systems for policy initiation,
compliance and review.
Mr. Osei Acheampong has over 20 years of work experience in sustainable
financing of health systems; developing strategies to strengthen
pharmaceutical supply chains and improving access to quality medicines;
developing contracting strategies for provider services and pharmaceuticals; provider payment
reforms; and regulatory and quality compliance.
Prior to joining the NHIA, Mr. Acheampong worked for leading health insurance and
pharmaceutical companies managing provider networks, provider contracts, drug formularies; and
developing cost containment strategies. He has also developed and managed initiatives to ensure
compliance to healthcare regulations.
Mr. Acheampong holds a Master of Science degree in Health Policy and Management from
Harvard School of Public Health specializing in healthcare financing, health insurance and
international health. He had earlier studied at Yale School of Management; and Brown University
where he obtained a Bachelor of Arts degree in Urban Studies.
Mr. Acheampong has served on the panel that developed WHO Guideline on Country
Pharmaceutical Pricing Policies; and Joint Learning Network (JLN) Costing Collaborative that
has developed Costing Manual for Provider Payment. He has also served as a resource person
and speaker in various international fora and conferences.
BEN KUSI: DIRECTOR IN-CHARGE OF MEMBERSHIP, PROVIDER
RELATIONS AND REGIONAL OPERATIONS
Prior to his present appointment, Mr. Ben Kusi worked with Bank of Ghana as
Head of Infrastructure and Project Manager on the IMPACT05 ICT project,
between 2004 and 2005. He had also worked with the British National Health
Service in the UK as ICT professional between 1998 and 2004. His expertise
ranges from People Management, Information Systems analysis and design,
Project Management and implementation of Enterprise Architecture
Solutions. Mr Ben Kusi holds a Bachelor of Science degree in Electronic Engineering from
Middlesex University, UK and a Post Graduate Diploma in Management Information Systems
Design from the University of Westminster, UK.
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DR. LYDIA DSANE-SELBY: DIRECTOR, CLAIMS
A Medical Doctor by profession, Dr. Lydia Dsane-Selby worked as Medical
Officer at Korle-Bu Teaching Hospital, Achimota Hospital and in the UK
prior to taking appointment at the NHIA. She was a Deputy Director of R&D
and later appointed the first Director of Clinical Audit of NHIA in 2010.
She holds an MBChB from the University of Ghana Medical School, Korle-
Bu and a Post Graduate in ENT Surgery from the Royal College of England.
She is an ICT Trained Microsoft Certified Professional.
DR. GUSTAV G.L. CRUICKSHANK: CHIEF AUDIT EXECUTIVE
Prior to his present appointment, Dr. Gustav G.L Cruickshank was a lecturer
in MBA, MSc and BSc degree programs in various institutions in the UK.
He also worked with organizations such as Arthur Andersen representative
office, Intercontinental Bank, LCBM (UK), Gabem Group (UK), Zenith
Aegis Ltd (UK and Ghana). He has over 15 years of international experience
in management consultancy, accounting, finance, auditing, operations and
strategic planning.
Dr. Gustav Cruickshank is a Chartered Accountant and has an MBA in Finance and PhD in
Strategic Management. He is a Fellow of the Association of Chartered Certified Accountants, UK
(FCCA), the Institute of Financial Accountants UK (FFA), and the Institute of Business
Consultancy UK (FIBC), a member of the Institute of Chartered Accountants, Ghana (ICAG) and
the Institute of Internal Auditors (IIA). He is a project management professional with the PRINCE
2 Practitioner qualification.
PERRY NELSON: DIRECTOR, MIS
Mr. Perry Nelson joined the NHIA in September 2009 as ICT Consultant
and assumed his current role in June 2010. He has over 23 years working
experience in the ICT industry and has played varied and critical roles in
several major ICT projects across the USA, United Kingdom, Africa, and
continental Europe. Perry has been ICT consultant to several blue chip
companies such as IBM, Universal Music, Toyota Motor Company (for
whom he spent over 7 years on several high profile projects), Bombardier, Lloyds TSB and Royal
Bank of Scotland. Mr. Perry Nelson earned his Bachelor of Science degree in Computer Science
from the Kwame Nkrumah University of Science and Technology in 1980.
Perry has been instrumental in the successful set up of the Claims Processing Centre (Accra) and
the development of strategies and policies for claims management within the NHIS.
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WINFRED AGBEIBOR: DIRECTOR, CORPORATE AFFAIRS
Winfred is a business planner and marketing communicator with over 14 years
experience in strategy, brand management, training and market research, from
Banking & Finance, through International Development & Medical Industry to
Consulting; both within and outside Ghana.
Before joining NHIA, he was the Commercial & Country Manager of the Nielsen
Company (ACNielsen) Ghana, and also served as Head of Strategy & Corporate Affairs of
Intercontinental Bank.
He has an MBA in Corporate Planning & Marketing from Vrije Universiteit Brussels, Belgium, a
Master of Human Ecology from same, and a BSc. Agriculture (Agricultural Economics) degree
from the University of Ghana.
EMMANUEL FIANKO, DIRECTOR, PROCUREMENT & PROJECTS
Mr. Emmanuel Fianko is a Procurement Specialist. He holds a Masters Degree
in Business Administration from the University of Ghana, Legon, BSc (Hons)
Mechanical Engineering from the University of Science and Technology,
Kumasi (now KNUST), and CIPS (UK) Qualification in Purchasing & Supply
Management, Certificates in World Bank and African Development Bank
(AfDB) Procurement Guidelines and Procedures among others.
Mr. Fianko is a member of the Ghana Institution of Engineers (Gh.IE). He has
over 24 years experience in the procurement of goods, works and services in both the Public and
Private Sectors covering Education, Health, Agriculture, Lands & Forestry, Energy and Banking.
He has performed the procurement functions using National, Multinational and Bilateral Donor
Guidelines and Procedures which include the World Bank, African Development Bank, the
European Union, British Department for International Development (DFID), USAID, UNESCO,
KFW (Germany), ECOWAS Bank for International Development (EBID), JICA and Spanish
Grant.
He was involved in the review of the Public Procurement Bill prior to its passage into Law (Public
Procurement Act 2003, Act 663). He has been lecturing on the World Bank Procurement
Regulations/Guidelines and the Public Procurement Act, 2003 (Act 663) since 2001.
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MS DIANA OYE AHENE, BOARD SECRETARY
Diana has over 26 years of work experience in senior roles working in both
private and public sectors in the areas of Para-Legal Services, Company
Secretarial Services, Administration, Programme Supervision, Monitoring
and Evaluation. For 22 years she worked in various capacities in one of
Ghana’s most esteemed law firms, Messrs Fugar & Company, as Personal
Assistant to the Head of Chambers; Administrator and Company Secretary.
She also represented the firm as Company Secretary to its corporate clients.
She holds an MSc in Health Policy, Planning and Financing from the London School of
Economics & Political Science; a Diploma in Health Policy Planning and Financing from the
London School of Hygiene & Tropical Medicine; a BBA from the University of Professional
Studies, Ghana. She has taken proficiency courses in corporate governance and administration.
BENJAMIN A. MARKIN YANKAH, CHIEF ACTUARY
Mr. Benjamin A. Markin Yankah has over 25 years working experience in
the public sector. Prior to his appointment as Actuary of the NHIA in 2008,
he was worked with the Social Security and National Insurance Trust
(SSNIT) as an Actuary. He was seconded to the Financial, Actuarial and
Statistical Services Branch of Social Security Department of the
International Labour Office (ILO) in 2002 where he served as the
Actuary/Finance Expert of the Ghana Social Trust Project – an initiative by
the ILO to support the extension of coverage of basic social security in developing countries based
on the principles of global social solidarity.
He was instrumental in the financial studies conducted by the ILO, Geneva, to support Ghana
government’s effort in introducing health insurance and subsequent actuarial valuations of the
National Health Insurance Scheme. He is a fellow of the Actuarial Society of Ghana. He holds a
Master of Science degree in Social Protection Financing with expertise in Actuarial modelling and
practice in Social Protection. He also holds a Bachelor of Science degree with honours in
Mathematics.
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ANTHONY GINGONG, DIRECTOR, QUALITY ASSURANCE
Prior to Joining the NHIA, Mr. Gingong was a District Director of Health
Services with the Ghana Health Service at Bole, as well as Associate
Consultant to Community Partnership for Health and Development. He has
worked extensively in the Ghana Health Service in both curative and preventive
sectors, as well as a Tutor at both the Community Health Nurses Training
School and the Tamale Nurses Training College.
He joined the NHIA as a Deputy Director of Operations in 2009 and became
the Director of Operations in 2013. He is currently the Director of Quality
Assurance, and the Coordinator for the Ghana Health Insurance Project.
Anthony Gingong holds an MSc in Population and Reproductive Health from the Kwame
Nkrumah University of Science and Technology, B.A. degree in Social Work and Sociology from
the University of Ghana, Postgraduate Diploma in Health Systems Management from the Galilee
International Management Institute, Advance National Diploma in Rural Medicine from the
Kintampo Rural Health Training School, and a State Registered Nursing Certificate from the
Tamale Nurses Training College.
Anthony Gingong has been instrumental in the creation of satellite offices, led the process of
increasing coverage for the poor, electronic claims piloting, Gatekeeper and medical referral
systems, as well as the development of Medical Terminologies for use by health care providers
and the NHIS.
MS MARY OWUSU, AG. DIRECTOR, ADMIN & HR
Ms Mary Owusu is the Acting Director for Administration and Human
Resource Directorate of the NHIA. She was the Deputy Director of Human
Resource for over three years during which period she was instrumental in
setting up the HR Department of the NHIA and putting in place HR systems
and structures. She has over twenty four years local and international experience
as an Administrator and an HR Practitioner in both the public and private sector.
She worked as an Administrator at Warner Interactive Entertainment and Training and Business
Group in the UK and at Ghana Atomic Energy Commission. She served as an HR Consultant at
Ernst and Young Ghana, Head of Human Capital and Head of Administration and Branch
Development at the then Intercontinental Bank Ghana Ltd. She also worked at PZ Cussons Ghana
as HR Manager.
Ms. Owusu obtained a B.A. Degree in Languages; French and Russian option and a Master of
Business Administration, HR option both at the University of Ghana, Legon. She has attended
various courses and international conferences on human resource and labour administration.
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AHMED IMORO: AG. DIRECTOR, FINANCE
Mr Ahmed Imoro joined the Controller and Accountant General Department in 1995
and was seconded to the National Health Insurance Authority as Principal Accountant
in 2005. He was later appointed the substantive Deputy Director of Finance and has
since 2009 been the Acting Director of Finance.
Mr Ahmed Imoro has a Master’s Degree in Business Administration (MBA-
Finance) and a Bachelor’s degree in Business Administration (Accounting and Finance)
from European University of Lefke.
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CHAIRMAN’S ACKNOWLEDGEMENT
In 2003, Ghana embarked on a journey to provide financial risk protection against the cost of quality
healthcare for all residents. This was a result of diligent search for a health financing option that addresses
the health needs of all residents in the country. Ten years on, through many sacrifices, the NHIS has become
a destination for many other countries who want to develop their health insurance schemes. There have
been opportunities and challenges, but together as a nation we have worked so hard to sustain the National
Health Insurance Scheme.
Four years ago when we took over as Board Members of the National Health Insurance Authority, little did
we know that much had been done, yet more needed to be achieved. Driven by the passion to ensure
financial access to healthcare for all residents, particularly the poor and vulnerable, we supported a number
of initiatives together with our stakeholders to better the good of the past. Notable amongst these were an
organizational re-engineering program that saw the development and implementation of an all-inclusive
medium-term strategic plan, the establishment of claims processing centre and the NHIS call centre, to
mention but a few.
The strategic planning process saw a re-definition of the vision and mission of the National Health Insurance
Scheme to meet the local and global needs of our time; the claims processing centre met the needs of our
service providers, contributing to fast claims processing; whilst the NHIS call centre is helping to meet the
growing education and information needs of our cherished subscribers in six languages every day of the
week.
Management and staff of the NHIS have not been left out of the picture. The Government of Ghana has
supported the Authority and its stakeholders to eliminate the administrative hiccups that were in the old
National Health Insurance Act 2003, (Act 650) through a legislative review process. We also salute with
great respect the bi-partisan manner in which the revised bill was smoothly passed by Parliament in 2012,
and greatly recognise with appreciation the speed with which His Excellency the President of the Republic
of Ghana, John Dramani Mahama, signed the National Health Insurance Act 2012, (Act 852) into law.
Following a thorough evaluation process to re-position the scheme and enhance the brand, the NHIA has
endorsed a new tagline – “Your access to healthcare”- for the scheme. Much as the enhanced brand and
tagline may look colourful and trendy, so does it place an increased responsibility on the managers of the
scheme to live up to the expectations of the people of Ghana. The two brand promises of instant issuance
of ID Cards and improved efficiency are core to subscribers and the people of Ghana.
On behalf of my colleague Board Members, I would like to thank management, staff, stakeholders and our
health care providers for their continued support that culminated in the achievements that were witnessed
in 2013.
Thank you.
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CHIEF EXECUTIVE’S REPORT
The year 2013 was significant for the important events and activities which took place as part of the
NHIA’s programme of reform and enhanced performance. The year was marked by far-reaching
organisational restructuring in line with the National Health Insurance Act, 2012 (Act 852).
The NHIA also commemorated the 10th anniversary of the enactment of the law that established the
National Health Insurance Scheme (NHIS). The 10th anniversary commemoration culminated in an
International Conference which was well patronised by the international community to affirm the rising
international profile of the NHIS.
Appointment of three Deputy Chief Executives
Three new Deputy Chief Executives (DCEs) Messrs Nathaniel Otoo, Edward Amissah-Nunoo and
Alex O. Nartey were appointed by His Excellency, the President of the Republic of Ghana in line with
the new NHIS law, the National Health Insurance Act, 2012 (Act 852) which makes provision for the
appointment of three Deputy Chief Executives. The three DCE’s were introduced to NHIA staff at the
Head Office on Thursday 5th June, 2013.
Introduction of Biometric Membership Registration (BMS)
The NHIA successfully piloted a biometric membership registration of subscribers at the Ayawaso and
La District Offices in the Greater Accra Region. The BMS is expected to improve ID card management,
clean up the membership database and to provide an effective verification (authentication) system at
the point of health care delivery. One of the key features of the Biometric ID Cards is the instant
issuance which resolves the problem of delays in ID Cards distribution and improves the experience
of subscribers.
Introduction of e-claims
Electronic Claims Processing was a strategy adopted by management in 2013 to address logistical
challenges associated with paper claims management, boost efficiency in claims processing, offer
transparency to providers and provide credible claims data for analysis. In April 2013, a pilot of e-
claims processing was instituted in 47 health care facilities with support from the Health Insurance
Project (HIP). E-claims submission is expected to be scaled up in the coming year.
Commissioning of regional office buildings
The NHIA embarked on construction of regional offices to provide permanent office accommodation
in the regions. In 2013, five regional offices (Greater Accra, Western, Ashanti, Volta and Upper West)
were commissioned. This brought the number of commissioned regional offices to seven. The
remaining three, which are near completion, will be commissioned in 2014.
Brand Enhancement
In view of the on-going organisational restructuring, growth of the scheme and international
recognition, all of which embody the changing identity of the NHIS, a new brand identity
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commensurate with its current profile and transformed identity was unveiled. The enhanced brand
comes with a dual brand promise: Instant issuance of NHIS ID Cards to subscribers and Improved
efficiency in the operations of the Scheme. The re-branding exercise was meant to renew public
confidence in the purpose of the NHIS and hopefully bestow all the benefits that a reinvigorated brand
identity has to offer. A New Tagline - The NHIS, “Your Access to Healthcare” and a New Logo were
introduced to represent the new NHIS, and to give stakeholders the expectation of a new experience
with the scheme.
NHIS@ 10 Commemoration
The 10th anniversary commemoration of the introduction of the National Health Insurance Scheme
(NHIS) provided an opportunity to acknowledge and express appreciation to all whose efforts and
dedication have contributed to the success of the NHIS as a cherished national institution and a
reference point on the international healthcare landscape. It was also a time to pause for reflection, to
redefine the corporate focus endanger a rededication of stakeholders to the course of the NHIS,
counting on the goodwill and support of all cherished subscribers, healthcare providers, staff,
development partners, and all other well-wishers to build on the modest achievements and the hard-
won international recognition that the NHIS has gained, by continuing to improve the scheme.
Outlook for 2014
1. Development of Medium Term Strategic Plan for the period 2015-2018.
2. Engagement of an External Agency to review the existing job descriptions and to develop job
descriptions for the new positions of Deputy Chief Executives (DCEs) consistent with the
mandate of the NHIA.
3. Engagement of a consultant to take charge of performance appraisal of Directors and review
that of DCEs beginning 2nd quarter through to the 3rd and 4th quarters of 2014.
4. Development of a new Transport Policy
5. Development of a new Maintenance Policy
6. Completion of Human Resource Policy review
7. Completion of scheme of service
8. Enrollment in the pharmaceutical supply chain / pricing
9. Outlining a Policy on sponsorship for post graduate training
10. Implementation of “360 degrees assessment”
xxii | P a g e
11. Development of operational manuals for the following:
a. E-Claims
b. Claims Processing Centres (CPCs)
c. Instant issuance of ID Cards based on biometric data
d. Capitation
e. Uniform Prescription Forms
f. Up-grading ICT infrastructure
g. Mainstreaming Monitoring & Evaluation
h. Increasing Membership/ Regional. & District targets
i. Improving Premium Collection
j. Developing and deepening relations with Development Partners ( DPs)
k. Clinical Audit
l. Claims verification
12. Intensification and mainstreaming of Mystery shopping to engender improvement on service
delivery and quality of care.
13. Promotion of partnership and collaboration with the University of Ghana, School of Public
Health to institutionalise knowledge sharing programmes and promote research on the NHIS.
14. Advancement of plans and preparations towards the establishment of a Health Insurance
Institute
15. Engagement of NHIS stakeholders on strategies to secure the long term future of the NHIS
Conclusion
The year 2013 has been very eventful. As the Chief Steward, I acknowledge and appreciate the team
effort and cordial working relationship with a technically efficient team of Deputy Chief Executives,
Directors, Deputy Directors, Managers and Officers of the Authority united in the pursuit of excellence.
I also wish to thank all NHIS stakeholders for their continued support and commitment to building a
sustainable health insurance scheme.
Thank you.
Sylvester A. Mensah
Chief Executive
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1.0 INTRODUCTION
The National Health Insurance Authority (NHIA) is mandated by law to secure the implementation
of the National Health Insurance Scheme. The Authority is responsible for the registration,
licensing and regulation of health insurance schemes in the country. It also grants credentialing to
healthcare providers and monitor their performance for efficient and quality service delivery. It is
responsible for managing the National Health Insurance Fund and devising mechanisms to ensure
that indigents are adequately catered for under the NHIS.
1.1 GOVERNANCE
The governing body of the Authority is a Board consisting of a Chairperson, the Chief Executive
and other members drawn from various stakeholder organisations. The Board is appointed by the
President of the Republic of Ghana, and is responsible for the proper and effective performance of
the functions of the Authority.
1.2 MANAGEMENT
The Executive Management of the Scheme is led by Mr. Sylvester A. Mensah, the Chief Executive
and assisted by three Deputy Chief Executives. Other members include technical directors and
deputy directors of various directorates/departments. To ensure accountability to stakeholders,
NHIS is decentralised to the regional and district levels. The full lists of Unit Heads and other
Managers, including Regional Managers of the NHIS may be found in the annex.
1.3 NHIS VALUE CHAIN
The value chain demonstrates how NHIS delivers value to subscribers through its primary and
supporting activities.
The primary activities are membership registration and ID card management, provider
credentialing and quality assurance, claims management and provider payments. These are
supported by secondary activities which include research and development, monitoring and
evaluation, ICT infrastructure and data management, financial and clinical audits, effective
communication with internal and external publics, human resource management, conflict
resolution and stakeholder management. Another key supporting activity is financing.
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Figure 1: NHIS Value Chain
1.4 CORPORATE GOALS
The corporate goals of the National Health Insurance Scheme are:
1. To attain a financially sustainable health insurance scheme.
2. To achieve universal financial access to basic health care services.
3. To secure stakeholder satisfaction.
1.5 CORPORATE OBJECTIVES FOR 2011-2014
The NHIS has developed a strategic plan to provide direction for the period 2011-2014 to enable
management focus on its core mandate. The plan envisages achieving the following corporate
objectives:
1. To mobilise 100% of the required funds by the end of 2014.
2. To increase efficiency in the financial operations of the scheme.
3. To increase active membership to 60% of the population by 2014.
4. To increase coverage of the vulnerable including the poor and the indigent to 70% by
2014.
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5. To provide support to increase access to quality basic health care services in all districts.
6. To strengthen governance systems and improve human resource capacity.
7. To improve the quality of services accessed by members in the national health insurance
system.
8. To improve the level of provider experience within the NHIS.
9. To improve involvement and participation in health insurance programmes.
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2.0 OPERATIONAL AND FINANCIAL REPORTS
2.1 Operational Report
2.1.1 Membership Management
Total NHIS active membership increased from 8,885,757 in 2012 to 10,145,196 in 2013. At the
end of 2013, active membership of the Scheme stood at 38% of the national population.
The table below shows new members, renewals, total active membership and percentage
distribution by region as at December 2013.
Table 1: Active Membership (2013)
Region New Renewals Active Membership
Percent of
Total
Ashanti 472,903 1,242,485
1,715,388 17%
Brong Ahafo 405,088
948,752
1,353,840 13%
Central 382,595
484,341
866,936 9%
Eastern 337,097
773,024
1,110,121 11%
Greater Accra 565,281
714,976
1,280,257 13%
Northern 391,728
488,789
880,517 9%
Upper East 166,538
476,740
643,278 6%
Upper West
99,620
322,797
422,417 4%
Volta 326,243
584,326
910,569 9%
Western 297,477
664,396
961,873 9%
Total
(National) 3,444,570 6,700,626 10,145,196
Ashanti region recorded the highest active membership followed by Brong Ahafo and Greater
Accra regions. The Upper West region registered the least, as a percentage of total active
membership.
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Table 2: Comparison of new registrations and renewals (2012/2013)
Year New Renewal Total
Active
membership as
% of national
population
2012 3,249,667 5,636,090 8,885,757 35%
2013 3,444,570 6,700,626 10,145,196 38%
Change 6% 19% 14% 3%
Three new categories of membership were added to the NHIS membership category namely,
Ghana Police, Military and Security Services. The chart below shows the distribution of NHIS
subscribers by category as at December 2013
Figure 2: NHIS Subscribers by Category as at December 2013
Children under 18 years constituted the largest percentage of active NHIS members, followed by
the informal sector. The Police, Military and Security Services constituted the lowest percentage
as shown in the chart above.
Informal33.6%
SSNIT Contributors3.6%
SSNIT Pensioners0.2%
Under 18 Years46.5%
70 Years And Above3.8%
Indigents12.1%
Police Service0.1%
Military0.2%
Security Services0.003%
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2.1.2 Free Maternal Care (FMC)
The Free Maternal Care program was introduced in July 2008 to contribute to meeting the
Millennium Development Goals (MDGs) 4 and 5. Under this program, pregnant women receive
free medical care. The table below shows the new registrations under the FMC.
Table 3: Registration under Free Maternal Care
Year Registration
2009 383,216
2010 504,609
2011 485,460
2012 754,658
2013 774,009
Total 2,901,952
2.1.3 Identification of the poor and vulnerable for exemption under the NHIS
One of the goals of the Medium Term Strategic Plan 2011-2014 of the National Health Insurance
Authority (NHIA) is to increase coverage of the poor and vulnerable under the Scheme. As part of
efforts to meeting this goal, the NHIA deployed various strategies to identify the poor and
vulnerable for exemption.
Under the current Legislative Instrument (LI 1809), for one to qualify as indigent, that person must
NOT have any identifiable source of income, must be unemployed and must NOT have any place
of abode. This provision makes it extremely difficult to identify persons who are poor and
vulnerable for exemption. In 2011, the NHIA in collaboration with the Department of Social
Welfare began to enroll beneficiaries of the Livelihood Empowerment Against Poverty (LEAP)
unto the scheme. The small number of LEAP beneficiaries coupled with stringent ‘means test’ for
the identification of indigents, resulted in the low enrollment of the poor and vulnerable persons
unto the Scheme. This therefore necessitated the need to secure innovative strategies that will
increase the enrollment of the poor and vulnerable persons unto the Scheme.
In June 2013, the NHIA extended the coverage of the poor and vulnerable to some selected existing
pro-poor interventions in Ghana. Thus, the NHIA identified some of the social intervention
programmes and enrolled beneficiaries of these programmes unto the scheme. Unprecedentedly,
this resulted in the registration of over 1,000,000 indigents.
As the country-wide Common Targeting Mechanism (CTM) for targeting and enrolling the poor
is not yet completed, the NHIA rode on the back of existing pro-poor interventions and
programmes in Ghana to identify and enroll the poor unto the scheme. The following proxies were
used to target and enroll prospective beneficiaries onto the NHIS in 2013:
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1. Beneficiaries of the Livelihood Empowerment Against Poverty (LEAP)
2. Children in orphanages across the country
3. Children who are blind, deaf and dump in special schools and in the community.
4. Mentally retarded and mentally ill patients within mental homes and in the community who
can be reached
5. Persons currently receiving financial support from recognized institutions such as the
District Assemblies and NGOs due to extreme poverty
6. Mothers with twins and triplets within the communities and are begging to feed them
7. People Living with HIV/AIDS who are poor and do not have any source of income
8. Persons being treated for Tuberculosis on Daily Observation Treatment (DOTs) and do
not have any source of income
9. Prisoners who are reported poor by the Prison Officers
10. Children who are receiving free school uniforms
11. Children benefiting from the School Feeding Programme
District Offices of the NHIA identified key stakeholders i.e. Ghana Education Service, Department
of Social Welfare, Opinion Leaders, among others within their respective areas of operations and
further engaged them on modalities for enrolling the beneficiaries.
In 2005, 23,238 indigents were enrolled unto the scheme. This grew by 111% in 2006, and by
December 2013 the number of indigents registered unto the scheme had increased in nominal terms
by about 5,000 percentage point. Table 4 and Figure 3 illustrate the operational statistics on
coverage of the indigent from 2005 to 2013.
Table 4: Indigent enrolment by year
Year No. of Indigents Enrolled % Change
2009 138,870 -
2010 117,295 -16%
2011 342,127 192%
2012 393,453 15%
2013 1,231,305 213%
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Figure 3: Indigent enrolment from 2009-2013 Indigent enrolment from 2009-2013
2.2 Creating geographical access to health care through credentialing of health care
facilities
In 2013, clinical audit and credentialing functions were integrated to leverage on their relatedness.
Since then, the NHIA has implemented various initiatives aimed at providing equitable health care
access to all NHIS Subscribers. The NHIA has been able to map credentialed facilities on an
approved template. A database for provider staff list has been developed and first batch of
credentialing applications have been reviewed in preparation towards renewal in the year 2014.
Also, inspections were conducted for all vetted applications for formal credentialing.
Between July 2009 and December 2013, a total of 3,943 facilities have applied for credentialing.
Out of this total, 3,822 representing 96.9% qualified and were fully credentialed, 45 facilities were
given provisional credentialing and 121 facilities representing 0.03% failed to meet the minimum
credentialing requirements. Credentialed facilities include Chemical Shops, CHP Zones, Clinics,
Dental Clinics, Diagnostic Centres, Eye Clinics, Health Centres, Laboratories, Maternal Homes,
Pharmacies, Physiotherapy, Polyclinics, Primary, Secondary and Tertiary Hospitals and
Ultrasound. Among these facilities, 1,197 CHPS Zones representing 31.3% came out as the highest
to receive credentialing.
Government facilities account for 2,075 representing 54.3% of credentialed facilities followed by
1,511 private facilities representing 39.5% of credentialed facilities. Other credentialed facilities
include the mission and quasi-government ownership.
The Ashanti Region has the highest number of credentialed facilities accounting for 619 facilities
representing 16.2%. This is followed by the Eastern Region with 514 (13.4%) credentialed
facilities whilst Western and Greater Accra followed with 460 (12.0%) and 440 (11.5%)
accredited facilities respectively. The Upper West Region has the lowest number of credentialed
facilities representing 5.1%. Admittedly, each region has equitable number of credentialed
facilities to serve NHIS Subscribers. Figure 4 represents credentialed facilities by region.
0
200000
400000
600000
800000
1000000
1200000
1400000
2009 2010 2011 2012 2013
138,870 117,295342,127 393,453
1,231,305
9 | P a g e
Figure 4: Credentialed Facilities by Region
619
376334
514
440
352
211 195
321
460
0
100
200
300
400
500
600
700
AR BA CR ER GAR NR UER UWR VR WR
No
.of
faci
litie
s
GOVERNMENT54%
MISSION5%
PRIVATE40%
QUASI-GOVT1%
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Figure 5: Credentialed Facilities by Ownership
Figure 6: Credentialed Facilities by Grade
Figure 7: Credentialed Facilities by Type
10
131
856
1632
1148
45
121
0
200
400
600
800
1000
1200
1400
1600
1800
GRADE A+ GRADE A GRADE B GRADE C GRADE D PROVISIONAL FAILED
No
.of
Faci
litie
s
236
1197
314
8 55 12
886
104224
345
1 19
339
11 170
0
200
400
600
800
1000
1200
1400
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2.3 Financial Report
The National Health Insurance Authority (NHIA) was first established by the National Health
Insurance Act, 2003 (Act 650). In 2012, the Act was repealed and replaced by a new law (Act
852). The object of the Authority under Act 852 is to attain universal health insurance coverage in
relation to persons residents in Ghana, and non-residents visiting Ghana, and to provide access to
healthcare services to the persons covered by the Scheme.
Section 39 of Act 852 established the National Health Insurance Fund (NHIF) and places
responsibility of its management on the shoulders of the Board. The object of the Fund is to provide
finance to subsidize the cost of provision of healthcare services to members of National Health
Insurance Scheme.
For the purpose of implementing the object of the Fund, section 40 (2) of Act 852 stipulates that
the monies from the Fund shall be expended as follows:
Pay for the healthcare costs of members of the National Health Insurance Scheme;
Pay for approved administrative expenses in relation to the running of the National Health
Insurance Scheme;
Facilitate the provision of or access to healthcare services; and
Invest in any other facilitating programmes to promote access to health services as may be
determined by the Minister in consultation with the Board.
The sources of money to the NHIF are provided under section 41 of the Act as follows:
National Health Insurance Levy (NHIL);
2.5 percentage points of each person’s 18.5% contribution to SSNIT pension fund;
Such moneys that may be allocated to the Fund by Parliament;
Grants, donation, gifts and any other voluntary contributions made to the fund,
Money that accrues to the Fund from investments made by the Authority
Fees charged by the Authority in the performance of its functions;
Contributions made by members of the Scheme; and
Moneys accrued under section 198 of the Insurance Act, 2006 (Act 724).
For the year ending 31st December 2013, the Authority earned a total revenue of GH¢904.30
million and incurred total expenditure of GH¢1,001.10 million resulting in a net operating deficit
of GH¢96.80 million. Claims cost for the period was GH¢785.64 million, representing 78.48%
of the total expenditure.
NHIL due from MOFEP at the end of the year 2013 was GH¢332.21 million. The Fund’s
investment portfolio (principal amount) stood at GH¢144.44 million as at 31 December 2013.
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2.3.1 Fund and Investment Management
As at 31st December 2013, the balance on the Authority’s investments, including accrued interest
stood at GH¢159.9 million, representing a 15.9% decrease from the GH¢190.2 million recorded
in 2012. The decrease resulted from disinvestments made toward the payment of maturing
healthcare claim obligations. The 2013 investment balance represented only 2.6 months (2012: 3.6
months) investment cover against healthcare claims, falling below the standard expected cover of
8 months. The decrease in investment also contributed to a 12.3% decline in the Fund Size from
GH¢201.91 million in 2012 to GH¢177.0 million in 2013.
In its efforts to ensure timely claims payment, the Authority, with the approval of the Ministry of
Finance, contracted a GH¢140.0 million syndicated facility in September 2012. As at December
31st 2013, the Authority had made a total repayment of GH¢66.9 million with the outstanding loan
balance of GH¢112.5 million. Further repayments are expected to be made to liquidate the facility
in 2014.
The portfolio earned an overall nominal rate of return of 23.2% in 2013 (2012: 16.7%). After
accounting for inflation, the real return on the investment portfolio was 10.3% (2012:6.5%),
exceeding the 2013 targeted 4% real return on investment. The Authority’s investments continued
to out-perform the rates on all benchmark money market instruments.
Figure 8: Investment Portfolios Returns
The Authority will continue to monitor the investment environment to position its investment
portfolio for optimal returns. We will also sustain efforts to restock the investment portfolio with
the view to gradually enhancing the investment cover towards the ideal cover of 8 months.
21.0%13.7% 16.2%
23.2%
10.8%
8.7%9.1%
11.7%
9.3%
4.5%6.5%
10.3%
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
40.0%
45.0%
50.0%
2010 2011 2012 2013
Ret
urn
s
NOMINAL RETURN AVERAGE INFLATION REAL RETURN
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3.0 CLAIMS MANAGEMENT
The NHIA continued the search for ways of improving its claims management in the year under
review. By the end of the year 2013, three new Claims Processing Centres (CPCs) have been set
up at Tamale, Kumasi, and Cape Coast. However, all these newly created CPCs could process
claims from 5 districts each instead of the entire claims from the respective regions. The premier
CPC in Accra added on only one district and 80 facilities to the existing number of districts and
facilities whose claims are being processed in Accra. In 2013, an electronic claims project (E-
Claims Project) was piloted, a software for implementing the National Claims Register was also
developed and a Claims Verification Unit was also set up.
Electronic Claims Processing was a strategy adopted by management in 2013 to address logistical
challenges associated with paper claims management, boost efficiency in claims processing, offer
transparency to providers and provide credible claims data for analysis. In April 2013, a pilot of
e-claims processing was instituted in 47 health care facilities with support from the Health
Insurance Project.
3.1 Out-patient Utilisation
Out-patient utilization of healthcare services increased from 23.9 million in 2012 to 27.35 million
in 2013. This was partly due to the introduction of capitation payment system in the Ashanti
Region which resulted in the reduction of ‘provider shopping’ and multiple visits to health care
facilities. Figure 9 presents outpatient utilization trend from 2009 to 2013.
Figure 9: Out-patient Utilisation Trend in Millions (2009-2013)
16.63 16.93
25.49 23.88
27.35
-
5.00
10.00
15.00
20.00
25.00
30.00
2009 2010 2011 2012 2013
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3.2 In-patient Utilisation
In-patient admissions increased from 1.43 million in 2012 to 1.61 million in 2013.
Figure 10 presents in-patient utilisation trend from 2009 to 2013
Figure 10: In-patient Utilization Trend in Millions (2009-2013)
Figure 11: Claims Payment Trend 2009-2013 (GH¢ Millions)
Claims payment increased from GH¢616.47 million in 2012 to GH¢785.64 million in 2013.
0.97
0.72
1.45 1.43
1.61
-
0.20
0.40
0.60
0.80
1.00
1.20
1.40
1.60
1.80
2009 2010 2011 2012 2013
362.64 397.61
548.71
616.47
785.64
-
100.00
200.00
300.00
400.00
500.00
600.00
700.00
800.00
900.00
2009 2010 2011 2012 2013
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4.0 HEALTH EQUITY
One of the principles underlying the design of the NHIS is equity which implies that everybody
has access to the minimum benefit package irrespective of people’s socio-economic background.
It also means that health insurance should be available all the time so that subscribers are not
denied access to health care when they need it. In this regard, the NHIS strives at all times to
achieve horizontal equity (equal treatment of individuals or groups in the same circumstances) and
vertical equity (individuals who are unequal are treated differently according to their level of need)
in its operations where applicable; enrolment, contribution (premium rate), access to healthcare
services, and financial protection.
4.1 Equity in health insurance coverage (enrolment)
In the year under review, the scheme increased its enrolment to 10,145,196 representing 38% of
the population. At the regional level, Ashanti region recorded the highest enrolment of 1.7 million,
followed by Brong Ahafo (1.4 million), Greater Accra (1.2 million), and Eastern region (1.1
million). The rest of the regions recorded less than 1 million people as shown in the table below.
Geographically, the distribution of NHIS coverage is a fair representation of the general population
distribution in the country, except Western, Brong Ahafo, and Volta Regions that recorded
remarkable figures relative to their populations. This trend is also reflected in sex distribution in
the country; the females constitute 51% of the total population and this is proportionally shown in
the share of enrolment (58%).
Table 11: Population and Enrolment Distribution, 2013
Region Population distribution* Health insurance coverage (enrolment)
Ashanti
5,123,308 (19.4%)
1,715,388 (16.9%)
Greater Accra
4,297,721 (16.3%)
1,280,257 (12.6)
Eastern
2,822,047 (10.7%)
1,110,121 (10.9%)
Northern
2,657,329 (10.1%)
880,517 (8.7%)
Western
2,546,468 (9.6%)
961,873 (9.5%)
Brong Ahafo
2,476,765 (9.4%)
1,353,840 (13.3%)
Central
2,359,817 (8.9%)
866,936 (8.5%)
Volta
2,270,208 (8.6%)
910,569 (9.0%)
Upper East
1,121,620 (2.8%)
643,278 (6.3%)
Upper West
752,477 (2.8%)
422,417 (4.2%)
National 26,427,760 (100%) 10,145,196 (100%)
*Population distribution is based on the 2013 projected population
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In terms of socio-economic status, the poor and vulnerable groups in the population (children
below 18years, the aged (70years and above)) are fairly represented in the membership base of the
scheme. These groups constitute more than 50% of the active membership coverage of the scheme
as shown in the membership management section (figure 2). The formal sector workers (SSNIT
contributors) and informal sector workers including the self-employed constitute 3.6% and 33.6%
respectively, representing a fair distribution of economically active population in the country.
4.2 Access by the poor and vulnerable to healthcare services
Access to healthcare has five main dimensions: affordability, accessibility, accommodation,
availability, and acceptability (5As). The affordability dimension falls within the domain of the
NHIS. The NHIS provides access to healthcare services to subscribers irrespective of their ethnic
and socio-economic background. This situation satisfies the principle of horizontal equity as
Ghana strives to achieve universal coverage and accelerate progress towards attainment of the
health-related MDGs, particularly goals 4 and 5. The introduction of Free Maternal Care (FMC)
programme and free registration of LEAP beneficiaries have contributed substantially to the
growing membership base of the scheme. The frequent joint mass registration exercises for head
porters (“kayeye”) being organized by NHIA and its stakeholders, for example, Word Bank and
other NGOs have also contributed to providing health insurance coverage and for that matter,
access to healthcare services for the poor and vulnerable in society.
Other operational activities of the NHIS such as credentialing of healthcare providers and payment
of healthcare provider claims contribute to improvement in accessibility and accommodation
dimensions of healthcare access. The increasing number of healthcare providers credentialed
across the country is ensuring geographical access to health care for all subscribers. As stated in
the healthcare provider section (page 7), a total of 3,822 providers have been credentialed between
July 2009 and December 2013 to provide healthcare services to subscribers. The spatial
distribution of these credentialed healthcare providers across the country is a general
representation of the regional membership base of the scheme as shown in the table below:
Table 12: Distribution of credentialed healthcare providers, 2013
Region Number of subscribers Number of Credentialed Healthcare
providers
Ashanti 1,715,388 619
Brong Ahafo 1,353,840 376
Greater Accra 1,280,257 440
Eastern 1,110,121 524
Western 961,873 460
Volta 910,569 321
Northern 880,517 352
Central 866,936 334
Upper East 643,278 211
Upper West 422,417 195
National 10,145,196 3,832
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Payment of claims constitutes over 80% of public healthcare providers’ IGF; this is facilitating
expansion of healthcare facilities (infrastructure and equipment) to accommodate the increasing
number of NHIS subscribers utilizing health services.
Besides, the NHIS statutory allocation of funds to MOH and the Parliamentarians is helping to
improve other dimensions of healthcare access, i.e. accessibility, availability, and accommodation.
For instance, the funds allocated to the Parliamentarians are used to undertake health-related
projects such as purchase of hospital beds, ambulances, etc.
4.3 Protection of the poor and vulnerable against financial risk
The large and growing number of disadvantaged groups in the membership base of the scheme is
an indication of a scheme that is making progress towards provision of financial protection to
marginalized groups in society. The principle of cross-subsidization inherent in the design of the
scheme ensures that the rich pay more to subsidize the poor, the healthier pay to cross-subsidize
the sick, and the economically active adults pay to cross-subsidize children and indigents. The
exemption of children below the age of 18 years, the aged (70years and above), and indigents from
paying contributions has also contributed to providing financial access to healthcare services for
these groups. Despite different contribution levels, the scheme provides universal benefit package
to all subscribers, thereby ensuring horizontal equity to utilization of healthcare service.
4.4 Premium (contributions) and National Health Insurance Levy (NHIL)
The design of the scheme has an inherent vertical equity in contributions, where the rich and
healthier people are required by law to pay more to support the less healthy, poor and vulnerable.
Since the formal sector employees’ health insurance contribution is income-rated and it is deducted
at source, it satisfies this legal requirement and the vertical equity principle. However, application
of this legal requirement to the large informal sector employees and the self-employed has been
administratively challenging due to fluctuations in their incomes and lack of data. In an attempt to
address this practical challenge and to increase enrolment in the early years of implementation, a
flat-rated contribution for all informal sector employees is levied. Although, this flat-rated
contribution satisfies horizontal equity and is helping to increase enrolment, it is regressive
because it overburdens the low income group in the population.
The progressive nature of the NHIL; however, is ensuring vertical equity in the financing of the
scheme. The NHIL is on selected goods and services deemed luxurious and frequently patronized
by the rich compared to the poor and vulnerable groups in society. This situation is having
progressive effect as it increases the tax burden of higher income families and reduces it on lower
income families.
4.5 Exemption strategy
The exemption strategies put in place to offer financial protection to the poor and vulnerable
groups in society, and to speed up progress towards achieving universal health coverage are the
FMC, contribution exemptions for children below 18years and the aged. Although, these strategies
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do not ensure vertical equity, where the rich and healthier amongst beneficiaries can pay to obtain
healthcare coverage, they contribute to improvement in maternal, neonatal, and child health
(MNCH) in the country.
Despite improvements in geographical, gender, and socio-economic equity in enrolment, there are
structural barriers including poor transportation network, long waiting times at both scheme and
provide sites, and inadequate spatial distribution of healthcare providers across the country that
limit access to healthcare services for subscribers particularly those in deprived areas in the
country. These factors fall within the accessibility dimension of access; therefore, there is the need
for inter-sectorial collaboration (e.g. Ministry of Health and Ministry of Transport) as well as
support from development partners) to address them.
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5.0 GOVERNANCE SYSTEMS
5.1 Effect of the implementation of the NHIS on the nation
The overall objective of the NHIS is to provide financial risk protection against the cost of quality
basic health care for all residents in Ghana. To do this the NHIA manages membership of the
scheme, pays medical claims on behalf of the members and also manages the National Health
Insurance Fund (NHIF)
Available data at the NHIA revealed that Out-patient utlilisation has been increasing since 2009
from 16.6 million to 23.8 million in 2012. This was confirmed by the 2012 Progress Report of the
Ghana Shared Growth and Development Agenda (GSGDA), 2010-2013, that OPD utilisation
indicated that OPD per capita continued to increase to 1.17 in 2012 compared to 1.05 in 2011. The
increase in health care utilisation has largely been attributed to increase in the proportion of insured
patients under the National Health Insurance Scheme. It has also been reported that, under the
NHIS, patients seek early health care thereby avoiding complications that lead to avoidable deaths.
Antenatal health care services improve pregnancy outcomes for both the mother and the child
and reduce maternal and infant mortality. The World Health Organisation (WHO) recommends
that a woman without complications must have at least 4 antenatal visits during pregnancy
starting during the first trimester of pregnancy. Information available in 2012 indicate that 9 out
of 10 pregnant women in Ghana attend at least one antenatal visit during pregnancy. Those
making 4 or more antenatal visits increased from 71.3% in 2011 to 72.3% in 2012. The increase
in antenatal visits has been attributed to the implementation of the Free Maternal Care Policy
under the NHIS. Special registration exercises are arranged for the poor and vulnerable,
including LEAP Beneficiaries to increase their enrolment unto the NHIS.
The NHIS has remained the single largest funding source for health care financing in Ghana
through the National Health Insurance Fund (NHIF). According to the Ghana National Health
Accounts, 2005 & 2010) Public funds from the NHIF increased from GH¢18.95 million in 2005
to GH¢409.63 million in 2010.
The NHIA uses well developed credentialing tools and trained health professionals to conduct
inspections of health care facilities for the purposes of credentialing them to provide service to
NHIS subscribers. To qualify for credentialing, health care facilities are required to satisfy
minimum set of criteria including personnel requirement as stipulated by the Credentialing tools.
The result is certain weakness in the health system have been exposed. Thus, the credentialing by
the NHIA has contributed to the strengthening of the health systems.
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5.2 Training and Development
In the year 2013, a total of 556 staff benefited from various training programs being sponsored by
the National Health Insurance Authority. The trainings were organised either locally or externally.
Fifty-six staff were trained abroad and 500 staff trained locally. The local training included those
trained in-house, as well as those trained in Training Institutions in Ghana. Ten staff benefitted
from educational sponsorship to pursue postgraduate studies in MBA Finance, Health
Management and Policy, Health Care Policy, Management Information Systems and Supply Chain
Management. In 2013, the NHIA supported the application of one staff member to secure
fellowship from the Netherlands Fellowship Program (NFP) to pursue a PhD Program in the
Netherlands.
5.2 Management Information System/Information Communication Technology
5.2.1 Biometric Membership System
A Nationwide ICT platform was implemented in 2005 to transform the operations of the NHIS. It
provided the scheme with the following:
1. A national network system with a central database that enabled the scheme to distribute its
services nationwide
2. Issuance of a single National ID for all subscribers
3. Enabled subscribers to enjoy portability
4. Made Healthcare Facilities capable of verifying the eligibility of subscribers.
However, there were some challenges that evolved with this system. These challenges were:
1. It sometimes took subscribers about 3 months or more to get NHIS card after registration.
2. Subscribers were able to register multiple times using different names and biographic data,
thereby creating data integrity issues with the central database.
3. The verification devices deployed were insufficient as well as inefficient for authenticating
subscribers.
In the midst of these challenges, NHIS has managed to keep the scheme running successfully,
while brainstorming on appropriate solutions for the ensuing challenges. In 2013, NHIA settled
on a biometric and instant ID card issuance system as solution to the above challenges.
The objectives of the BMS are summarized as:
a. Issue instant biometric NHIS membership ID card to subscribers.
b. Improve on the integrity of the membership database.
c. Improve subscriber authentication at healthcare facilities.
d. Generate unique code (Claims Check Code) for subscribers who access health care,
and to match each claim to subscriber attendance.
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Achievement of the above objectives will enable the Authority to improve the quality of its
services to the subscribers and providers, and the quality of data for analysis and information for
decision-making.
The project was scoped to cover the following;
1. Set-up a centralized BMS with the capability to support all district offices nationwide to
register and issue instant biometric ID cards;
2. Provide the technology that will aid instant printing of biometric ID card locally at all
schemes; and
3. Provide effective authentication system that verifies finger print with the details captured
on the biometric ID card.
The project was successfully piloted in La and Ayawaso Districts. Achievements include:
1. Development, testing and corrections of the application to make it more reliable;
2. Configuration of the different parts of the system to form a workstation for biometric
registration and instant issuance of ID cards; and
3. Development of a mobile biometric registration device.
The BMS is expected to be rolled-out to other parts of the country in 2014.
5.2.2 Data Centre Upgrade
A major upgrade of the Data Centre (DC) was started in 2013. The Data Centre (DC) upgrade is a
programme required to bring the IT system of the NHIA up-to-date and re-aligned to business
goals and objectives. Most of the DC IT infrastructure, having been in service for the past 5 years,
have aged and reached their end-of-life, and need to be upgraded.
The DC upgrade is a phased program. Phase 1 is the upgrade of the core database and application
servers from 32-bit servers to 64-bit servers. This phase is expected to bring about stability and
availability of the line-of-business applications of the NHIS. Phase 1 will also allow for the easy
integration of the Biometric features into the Membership module.
Phase 2 of the programme will involve the installation of new storage systems, upgrade of the E-
business suite (EBS) application and e-mail platform to state-of-the-art. This phase will close the
loop of activities required to ensure a stable IT platform.
5.3 Oversight of Private Health Insurance Schemes (PHIS)
The National Health Insurance Act, 2012 (Act 852), mandates the National Health Insurance
Authority to register and supervise Private Health Insurance Schemes in Ghana. In accordance
with this mandate, the Authority has registered and licensed 14 Private Mutual Health Insurance
Schemes and 3 Private Commercial Health Insurance Schemes to provide financial access to
healthcare for its current 144,625 registered members. Unlike the National Health Insurance
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Authority, the target market of most of the schemes is employees and families. The Authority
conducted periodic inspections as part of its monitoring and supervisory role to ensure quality of
care.
In the year 2013, the department reviewed all financial projections received from PHIS, and drafted
the agreement on the establishment of Escrow Account for Private Commercial Schemes. A Policy
Manual for regulating and supervising the operations of Private Health Insurance Schemes was
drafted, and about 80% of work on the checklist for pre and post licensing inspections was
completed. Names of licensed PHIS in good standing were published in the newspapers.
The main challenges facing the Department include difficulties in processing application forms for
license due to delayed feedback and manual processing of applications and inadequate technical
capacity of staff.
5.4 Organisational Reforms in 2013
The NHIA underwent a major restructuring in May 2013 following the passage of the new National
Health Insurance Act, 2012 (Act 852) by Parliament.
5.4.1 The Structure of the Organisation under Act 650
Under Act 650, the Authority was governed by the National Health Insurance Council and headed
by the Chief Executive whose mandate was to oversee the day to day administration of the affairs
of the Authority and implementation of the decisions of the Council.
The Authority was managed through 12 Divisions which were headed by Directors. The Divisions
were further sub-divided into Departments and Units headed by Deputy Directors and Managers
respectively. There were 10 regional offices across the regional capitals which were headed by
Regional Managers.
There were also145 District Mutual Health Insurance Schemes supervised by the Authority as the
regulator, supervisor and implementer of the Health Insurance Scheme. Each Scheme was headed
by a Scheme Manager under the direction of a Board and operated as companies limited by
guarantee.
5.4.2 The Structure of the Organisation under Act 852
The organization was restructured in May 2013 to align with the provisions of the new Act which
required the appointment of 3 Deputy Chief Executives to assist the Chief Executive in carrying
out the mandate of the Authority.
In June 2013, the Deputy Chief Executives assumed their respective positions following their
appointment by the president to be responsible for:
Operations
Administration & Human Resource
Finance & Investment
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The 12 Divisions under the old structure were reorganized into Directorates after a review of their
functions and designations. The Directorates were divided into Departments and Units. The
Directorates are headed by Directors whilst the Departments and Units are headed by Deputy
Directors and Managers respectively.
The regional offices have been restructured to be headed by Deputy Directors. A major highlight
of the restructuring has been the dissolution of the old District Mutual Health Insurance Schemes
and their replacement with District Offices of the NHIA. Fifteen District Offices have been set up
in addition to the previous 145 former Schemes bringing the total to 160 District Offices. These
are headed by District Managers
The tables below illustrate some changes brought about by the restructuring.
Change in names of the former Divisions (now Directorates)
Name under the old structure (Division) Name under the new structure
(Directorate)
Administration and General Counsel Administration and Human Resource
Strategy and Corporate Affairs Corporate Affairs
Operations Membership, Provider Relations and Regional
Operations
Information Communication Technology Management Information Systems
Clinical Audit Quality Assurance
Besides the Directorates which are within Divisions that are headed by Directors and supervised
by Deputy Chief Executives, there are others which for strategic purposes report directly to the
Chief Executive. These are:
Directorates
1. Internal Audit
2. Actuary
Departments
3. Planning, Monitoring & Evaluation / International Relations
4. Legal
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Structure of the Divisions
Division Directorates in Division Stand-alone Departments in
Division/Units
1. Operations 1. Membership, Provider
Relations & Regional
Operations
2. Research and Development
3. Quality Assurance
4. Management Information
Systems
1. Private Health Insurance
Schemes
2. Administration &
Human Resources
1. Administration & Human
Resources
2. Corporate Affairs
3. Procurement and Projects
1. Training and Development
2. Security & Safety
3. Finance &
Investment
1. Finance
2. Claims
1. Fund & Investment
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6.0 COMMUNICATION AND STAKEHOLDER ENGAGEMENTS
As part of efforts to increase the involvement of stakeholders in NHIA activities, series of
engagements with stakeholders are held year to deliberate on specific issues relating to
improvement in the operations of the scheme. The 2013 Stakeholders engagement was held in
March 2014. However, the last quarter of 2013 was used to commemorate the 10th Anniversary of
the establishment of the Scheme. This commemoration attracted the participation of major
stakeholder groups including the international community.
The 2013 Stakeholders meeting was attended by 286 participants made up of staff of NHIS, NHIA
Board Members, Members of Parliamentary Select Committee on Health, NHIS Subscribers,
Development Partners, Academia, representatives from Ministries of Health and Finance and
various health care provider groups. Also in attendance were representatives from regulatory
bodies and associations such as Ghana Medical and Dental Council, Ghana Registered Nurses and
Midwifery Council, Ghana Medical Association and Health Insurance Service Providers
Association of Ghana among others. The meeting was graced by Ghana’s Minister of Health, Hon.
Sherry Ayittey and her counterpart from Ethiopia who was on a working visit to Ghana.
The main objectives of the meeting were to:
Present new programmes and projects of the scheme to stakeholders for their input and
buy-in.
Discuss the Operational and financial challenges confronting the NHIS and solicit support
to sustain the NHIS.
Provide a platform for key stakeholders to present their concerns and views about the
implementation of the NHIS and assist to chart a common path to improve the scheme.
Key among the issues discussed were the scaling-up of e-Claims, instant ID card issuance through
Biometric Membership System, Claims Processing Centres, scaling-up of Capitation, status of
implementation of NHIA strategic plan and the sustainability of the NHIS.
On the achievements of the NHIS, Mr. Sylvester Mensah mentioned that in a relatively short period
of implementation of the NHIS, the scheme has engaged the attention of institutions, governments,
researchers and the international healthcare community at large. The NHIS sustains the healthcare
industry involving more than 3,500 health care providers and numerous suppliers. He further
mentioned that despite some challenges, the NHIS has emerged as a model of financial risk
protection for up to 9 million active subscribers with access to a benefit package which is
considered generous by global standards. The NHIS has become a hub for knowledge and
experience sharing attracting delegations from various countries and institutions.
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At the 2013 Stakeholders meeting, the NHIA indicated that it will be a little harsh on errors in
claims submission, and that effective 1st March 2014, all claims emanating from providers should
be authenticated by the medical head of the facility without which the claims will be invalid. The
NHIA will continue with the capitation roll out in Upper West, Upper East and the Volta Regions.
Additionally, the NHIA will begin a phase implementation of the new MOH prescription forms
and will also accelerate the instant ID card issuance as well as coverage of claims processing in
the four claims processing centres across the country.
Stakeholders at the meeting applauded the presentation by School of Public Health for the
insightful presentation on possible areas of research collaboration with the NHIA, and assured
them that they will certainly be the preferred choice when the NHIS settles on the areas of research.
The NHIA also indicated its willingness to support some of the young graduates to pursue short
courses and post graduate programmes.
Participants at the meeting were grateful for the opportunity to be part of the NHIA
6.1 Study tour
The NHIS continued to attract the attention of the international community as many countries
visited Ghana to understudy the NHIS. In 2013, delegations from 5 countries namely Korea,
Ethiopia, Nigeria, Benin and Senegal visited Ghana to understudy the operations of the NHIS. The
visits created the platforms for information and knowledge sharing between Ghana and the visiting
countries. Delegations from the South Korea Foundation for International Healthcare (KOFIH)
visited Ghana to collaborate with the NHIA on common areas of research. Consequently, 2 staff
of the NHIA benefitted from a research study in Korea. The collaboration is on-going and more
NHIA staff are expected to benefit in 2014.
6.2 Collaboration with Development Partners
The National Health Insurance Authority (NHIA) has had the support of Development Partners
over the years. Currently there are 9 Development Partners that are providing either financial or
technical assistance to the NHIA. Below is the list of the DPs:
The Danish International Development Assistance (DANIDA)
The United States Agency for International Development (USAID)
The Royal Netherlands Embassy (EKN)
The British Department for International Development (DfID)
The Korean Foundation for International Health Care (KOFIH)
The African Development Bank (AfDB)
The International Finance Corporation
The World Bank
The Rockefeller Foundation
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The Danish International Development Assistance (DANIDA)
The Danish International Development Assistance (DANIDA) sponsored the training of 20
Regional M&E Officers and 10 NHIA head office staff in M&E at GIMPA in 2011. They also
sponsored the training of all District and Regional PROs across the country in 2011/2012.
Currently, they are supporting the NHIA/S with an embedded Senior Strategic Planning,
Monitoring and Evaluation Advisor to provide technical advice in the development and
mainstreaming of an M&E system within the NHIS. The Advisor is on a long term contract of
three years, beginning in February 2012 and scheduled to end in January 2015.
The United States Agency for International Development (USAID)
The USAID has concluded initial discussions with management of NHIA to support the NHIS
with multiple projects. A Team of Consultants have been engaged to work with the NHIA to take
the projects to the next level (development and implementation). Initial assessment had been
concluded and report with recommendations presented to NHIA for study and discussion. The
proposed projects to be supported by USAID include:
Clinical Audit: working with USAID to support clinical audit activities in the year 2014
and possibly beyond. USAID is in the process of finishing the implementation letter and the budget
that was sent to them.
Accreditation: In 2013, a Concept paper was submitted to the USAID of which they
acknowledged receipt. Since then, no feedback has been received from them.
Evidence Based Purchaser: Work on proposal is still on-going by USAID and the initial
meeting was to solicit inputs from the group.
The Royal Netherlands Embassy (EKN)
The EKN has expressed interest to support the NHIA e-claims project as well as the establishment
of a Health Insurance Knowledge Centre in Ghana. However, they could not move beyond
expression of intent with respect to the e-claims project. The Knowledge Centre was to be
supported through Pharm Access. It was intended that, the centre would be turned into a Pan-
African Knowledge Centre and jointly owned by Ghana and any other interested African countries.
Uganda associated itself with the project. Consultants from Ghana and Uganda were engaged to
conduct a feasibility study. The findings of the study were presented to stakeholders in Ghana in
early 2013. Currently no feedback on progress so far has been received.
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The British Department for International Development (DfID)
The initial development assistance offered to the NHIS ended in 2012, but currently they have
approved about 1.7m British Pounds to support improvement of NHIA’s financial management
system. NHIA has been notified of the release of the first tranche of funding and requested to
submit detailed work-plan to the MOH for the release of the funds to NHIA. The Finance
Directorate is currently working on the detailed work-plan.
The Korean Foundation for International Healthcare (KOFIH)
The Korean Foundation for International Healthcare expressed interest towards the end of year
2012 in assisting the NHIA to undertake comparative research studies of both the Ghana and South
Korea Health Insurance Schemes in order to share ideas on how best to move both countries’ health
insurance forward. South Korea allocated $340,000 to fund the project in the year 2013. Two
middle level staff members were invited to Korea for 3 and 6 months short courses/research in
health financing. Four senior staff of the NHIA also attended short training courses in Korea in
2013. Follow-up policy consulting meeting was held in Ghana in November, 2013 where KOFIH
agreed to continue with the project, beginning with a feasibility study and pilot implementation in
2014. A proposal has been submitted and approved tentatively for the project to begin in 2014.
The African Development Bank (AfDB)
Concept papers on NHIS Knowledge Centre, E-payment project, IT Infrastructure Development,
M&E Policy Development, Small Grants Scheme and Performance Management System have
been submitted to the AfDB. Subsequently, a follow-up meeting was held on July 17, 2013 at the
premises of the Bank.
The International Finance Corporation (IFC)
The International Finance Corporation (IFC) works through the AHME project funded by the
Gates Foundation. Partners of the AHME Project are Pharm Access, Marie Stopes and Grameen
Foundation. The project seeks to improve the identification and registration of the poor using an
electronic- based proxy means test to support biometric registration system to increase coverage
of the poor. Also the IFC has introduced mobile phone platform to increase pro-poor registration,
and also to support capitation and Preferred Primary Provider registration. They also intend
building the technical and managerial capacity of NHIA Staff. The Project has been approved by
the Steering committee of the Gates Foundation. Proposal for support to mainstream M & E system
within the NHIS has also been presented for consideration.
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The World Bank
They are also helping the Scheme to improve its ability to pay claims and support the Health Data
Dictionary (HDD), IT support system for both the NHIA and the entire health sector. With the
HDD, the Health Insurance Project (HIP) seeks to expand E-Claims, Biometric registration,
Capitation roll out and support the implementation of RBF.
The Rockefeller Foundation
The Rockefeller Foundation has proposed to invite stakeholders of MOH to UK on study visit to
learn about British NHS.
6.3 Policy consulting between NHIA and KOFIH
A three-day consultative dialogue between the National Health Insurance Authority (NHIA) and
the Korean Foundation for International Healthcare (KOFIH) was held in 2013 with the
commitment by the two countries to collaborate more effectively in areas of mutual interest. Three
of such policy dialogues between Korea and Ghana were held in the year.
6.4 Policy Fair
The NHIA participated in the 4th Ghana Policy Fair aimed at creating a platform for Ghanaians to
interact with policy makers and implementers to be informed about projects undertaken by various
government agencies. The 3-day Policy Fair started in Accra on 15th of October, 2013 under the
theme: “Partnership and Innovation for Development”. The NHIA used the opportunity to explain
the operations of the NHIS with the general public and some subscribers. The occasion was also
used to register new subscribers unto the Scheme. Staff from the Kpeshie District Office of the
NHIA mounted an exhibition and also registered a total of 76 new subscribers during the period.
A total of 586 persons visited the NHIA stand.
6.5 Media Interactions
The NHIA organised a number of media interaction programs with senior editors and journalists
on critical issues. These engagements enabled the NHIA to provide first-hand information to these
media practitioners on activities of the Scheme.
In April, 2013, the NHIA held a press conference to announce its revised tariffs. In June, 2013, a
media interaction was organized between the NHIA and some senior media personnel on the
importance of the Scheme adopting a biometric solution to address a number of its challenges.
Press kits with vital information were prepared for the senior editors and journalists to facilitate
their appreciation of the issues discussed and make referencing easy. New Live Presenter Mentions
(LPMs), Jingles, documentaries and TV adverts were produced and aired to educate the public on
key aspects of the Scheme.
The Media and Communications team embarked on visits to selected media houses to interact with
their senior editors. Numerous radio and TV interviews were also granted on issues including
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Capitation, Biometric Solution, NHIS Call Centre, 10th anniversary and general issues on the
Scheme.
6.6 Brand Enhancement
Against the backdrop of organisational restructuring, growth of the Scheme and international
recognition, all of which embody the changing identity of the NHIS, a new brand was unveiled to
commensurate with its current profile and transformed identity. The new brand brought a dual
brand promise: Instant issuance of NHIS ID Cards to subscribers and improved efficiency in the
operations of the Scheme. The re-branding exercise also sort to renew public faith in the purpose
of the NHIS and hopefully bestow all the benefits that a reinvigorated brand identity has to offer.
A New Tagline - The NHIS, “Your Access to Healthcare” and a New Logo were introduced to
represent the new NHIS, and to give stakeholders the expectation of a new experience with the
scheme.
6.7 NHIS@10 Commemoration
The NHIS was established in 2013 by an Act of Parliament, the National Health Insurance Act,
(Act 650). Thus, in 2013, the NHIS commemorated 10 years of its existence with a line-up of
activities which ended with a well-attended 2-day International Conference.
The formal launch of the 10th Anniversary of the National Health Insurance Scheme took place at
the Holiday Inn Hotel in Accra on 19th September, 2013 under the theme 'Towards Universal
Health Coverage: Increasing Enrolment whilst Ensuring Sustainability'. It was attended by
dignitaries and staff of the NHIA/NHIS. The new logo of the NHIA was unveiled during the
launch. The 10th Anniversary was considered as the end of an opening chapter in the unfolding
story of the NHIS.
6.7.1 NHIS@10 International Conference
The NHIS@10 commemoration ended with a 2-day International Conference which was attended
by participants from over 40 countries. Participants at the International conference called on
government and health policy makers in Ghana to consider expanding the coverage of the Scheme.
Though overwhelmingly, the International Health Financing and Universal Health Coverage
(UHC) experts who gathered for the conference agreed that in 10 years, Ghana has made
significant strides towards nation-wide coverage, the country was urged to make more resources
available to the NHIS in order to intensify its coverage efforts.
The call for more resources by conference participants was rooted in the aspiration to get more
people, especially the vulnerable, onto the Scheme. According to the Conference, resource
allocation to the NHIS must increase with membership growth to guarantee the Scheme’s
sustainability. The theme for the conference was, “Towards Universal Health
Coverage: Increasing Enrolment whilst Ensuring Sustainability”.
Ghana was praised for the bi-partisan political support its health insurance is receiving that
manifested recently in the smooth passage of Act 852 which replaced Act 650.
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NHIS@10 in Pictures
Delegates receiving assistance at the registration desk
NHIS@10 in Pictures
Delegates receiving assistance at the registration desk
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Mr. Sylvester A. Mensah, Chief Executive of the NHIA being ushered into the Conference Hall by Ms. Pearl
Nkrumah of the NHIA
Accra International Conference Centre, the venue for the NHIS@10 Conference
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6.7.2 NHIS@10 Quiz Competition
As part of activities marking the 10th anniversary commemoration of the establishment of the
NHIS, a national quiz competition was organized for 40 Senior High Schools. The purpose of the
competition was to test the knowledge of students on the NHIS and also through the contest,
educate the public on some health insurance matters.
The Aburaman Senior High School in the Central Region emerged winners of the NHIS@10
national quiz competition. The school demonstrated their command and understanding of NHIS
related issues by beating many other schools from the regional and zonal levels to reach the final.
They displaced three other schools in the final to win a Health and Sanitation Project of the
school’s choice valued at GH¢10,000 and a trophy. St Francis of Assisi Girls’ SHS in the Upper
West Region came second, followed by Archbishop Porter’s Girls Senior High School in the
Western region and Bolgatanga Girls Senior High School in the Upper East Region.
In all, forty senior high schools drawn from all ten regions of the country, including Ghana
Secondary Technical School, St Peters Senior High School, Aburi Girls Senior High School in the
Western Region, Tamale Senior High School, Sunyani Senior High School, locked horns at
various levels over a one month period, in their quest to qualify for the finals.
Each of the four finalists received a 42” Flat screen Plasma Television set, a jumbo water tank and
400 exercise books donated by Cowbell, and other NHIS branded souvenirs. In addition to these
prizes, the National Health Insurance Authority (NHIA) presented a cheque of ten thousand Ghana
cedis (GH¢10,000) to the winners, Aburaman Senior High School to support Water and Sanitation
Project for the School.
Presenting the cheque to the school, Director of Corporate Affairs at the NHIA, Winfred Agbeibor
encouraged the students to study hard so they can become great leaders of tomorrow. He also
challenged them to always strive to keep flying high the flag of the school. He also congratulated
the two students, Priscilla Yeboah and Viola Adams who represented the school, for making
themselves and Aburaman SHS proud. The Headmistress of the school, Madam Alberta Obiriwa
Rigg Stewart was grateful to the NHIA for the gesture and appealed for further assistance for the
school. According to her, the mechanized borehole (water and sanitation project) will facilitate
learning and ensure discipline in the school as this will prevent students from going out at all times
in the name of looking for water.
6.7.3 NHIS@10 Special Thanksgiving and Awards Service
The NHIA organised a special thanksgiving service to conclude the activities marking the
NHIS@10 commemoration at the forecourt of the NHIA Building in Accra. The special
thanksgiving was an occasion to thank God for his protection and guidance for the past 10 years.
It was also to recognise the contributions of selected NHIA Staff who have excelled in their areas
of operations. Among the recipients of the awards were Mr. Nathaniel Otoo who chaired the
NHIS@10 Commemoration Committee, selected Directors, Deputy Directors and non-
management staff. In attendance was the Perez Chapel International Orchestra
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NHIS@10 Thanksgiving Service in Pictures
Mr. Sylvester A. Mensah delivering a speech at the NHIS@10 Thanksgiving Service
NHIS@10 Thanksgiving Service in Pictures
Mr. Sylvester A. Mensah presenting an award to Mr. Washington Komla Darke, Deputy Director in charge of Fund Management
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Perez Chapel International Orchestra in display at the NHIS@10 Thanksgiving Service
NHIS@10 Thanksgiving Service in Pictures
Mr. Sylvester A. Mensah, Chief Executive of the service NHIA praising God in a special danc
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A section of NHIA staff enjoying the thanksgiving service
A section of NHIA staff applauding the Chief Executive’s dance
Conclusion and Recommendations
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The NHIA experienced significant growth and development in the year under review. The
implementation of the new law, Act 852 began with the appointment of 3 Deputy Chief Executives
as part of an on-going organisational restructuring. Active membership of NHIS subscribers grew
from 34% to 38.3%. In 2013, the NHIA commemorated 10 years of its existence with an
International Conference which was attended by participants from over 40 countries.
For improvement in the operations of the NHIS, it is recommended that the NHIA should:
Lobby Parliament to increase the funding sources of the NHIS
Lobby Parliament to increase the NHIL (VAT)
Review its Benefit Package in line with best practice and international evidence
Continue to pursue cost containment and prudent financial management measures
Continue to educate registered members to renew their membership on expiration
Embark on aggressive membership drive
Register all students in both Junior and Senior High Schools in the country
Continue to liaise with the Department of Social Welfare to enroll all LEAP Beneficiaries
Continue to provide exemptions for the poor and vulnerable
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APPENDIX 1: TRAINING PROGRAMMES ORGANISED IN 2013
Training No. of
Training
Total no. of
Participants
Head
Office
Regional
Offices
District
Offices
Others
External 32 59 58 0 0 1
Internal 34 364 258 94 12 0
In-House 4 86 76 1 9 0
Orientation 1 33 20 3 10
Knowledge
Sharing
1 14 14
Total no. of
Training
72 556 426 98 31 1
Masters
Sponsorship
10 10 6 1 3
Bond 10 6 1 3
39 | P a g e
APPENDIX 2: UNAUDITED FINANCIAL STATEMENT
NATIONAL HEALTH INSURANCE AUTHOPRITY
REVENUE AND EXPENDITURE ACCOUNT
For The Year Ended 31st December 2013
REVENUE Note 2013 2012
GH¢’m GH¢’m
NHIL 2 650.20 573.36
SSNIT Contribution 180.49 141.76
Investment Income 42.25 29.07
Premium 30.58 28.56
Reinsurance - NIC 0.22 0.30
Sundry Income 0.56 1.45
904.30 774.50
EXPENDITURE
Claims Incurred to Service Providers 785.64 616.21
NHIS ID Card Expenses 27.69 20.05
Support to Ministry of Health 3 31.68 74.67
Admin. & Log. Support to Dist. Offices 4 4.31 6.93
NHIA General Operating Expenses 5 101.42 60.20
Interest on Loan 38.60 11.15
Depreciation 11.76 10.81
1,001.10 800.02
Operating Deficit (96.80) (25.52)
Statement of Financial Position as at 31 December, 2013
Notes GH¢’ million
2013
Dec. 31
GH¢’ million
2012
Dec. 31
NON-CURRENT ASSETS
Property, Plant & Equipment 6 77.71 40.83
INVESTMENTS 7 144.44 168.92
CURRENT ASSETS
NHI Levies Receivables 332.21 335.41
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Investment Income Receivable 8 15.51 15.48
Claims Prepayment – Capitation 0.00 1.64
Other Receivables 9 1.47 2.04
Cash & Bank 10 30.32 24.60
Total Current Assets 379.51 379.17
TOTAL ASSETS 601.66 588.92
ACCUMULATED FUNDS &
LIABILITIES
Liabilities
Claims Payable 360.78 220.52
Payable to MOH & others 11 23.12 17.14
Bank Loans 12 104.80 140.00
Bank Loan Interest Accrued 12 7.69 9.40
Total Liabilities 496.39 387.06
Accumulated Funds 13 105.27 201.86
TOTAL ACCUMULATED FUND &
LIABILITIES
601.66 588.92
Cash flow Statement for the period ending 31 December, 2013
Notes
GH¢’ million GH¢’
million
Cash flow from Operating Activities
Net Operating deficit (96.80)
Adjusting for:
Provision for Depreciation 11.76
Decrease in Accounts Receivable 3.95
Decrease in Prepayment 1.64
Increase in Claims Payable 140.26
Increase in Other Payables 4.27 161.88
65.08
Cash flow from Investing Activities
41 | P a g e
Decrease in Investments 24.48
Purchase of Fixed Assets (48.64)
(24.16)
Cashflow from Financing Activities
Payment of Bank Loan
(35.20)
Changes in Cash & Cash Equivalent 5.72
Analysis of Changes in Cash & Cash Equivalent
During the Year
Balance as at Jan-1, 2013 24.60
Changes in Cash & Cash Equivalent 5.72
Balance as at 31 Dec., 2013 30.32
Analysis of Cash & Cash Equivalence As Shown in the
Balance Sheet
Cash 0.17
Bank 30.15
30.32
NOTES FORMING PART OF THE ACCOUNTS
NOTE 1 - ACCOUNTING POLICIES
1.1.1 Basis of Preparation
The principal accounting policies applied in preparation of these accounts are set out below:
The Financial statements have been prepared on a historical cost basis. The statements are also
prepared in accordance with International Financial Reporting Standards, the companies codes 1963
(Act 179), and in compliance to National Health Insurance Act 852.
The accounting policies have been applied consistently throughout the period.
1.1.2 Revenue
Revenue is recognized to the extent that it is probable that the economic benefits will flow to the
Authority and can be reliably measured. Revenue is measured at the fair value of the consideration
received or fair estimate of the amount receivable.
The main revenue for the Authority are the following; the 2.5% national health insurance levy, 2.5%
social security contribution, income from investment and premium from subscribers.
42 | P a g e
1.1.3 Investments
Investment in fixed deposits is valued at cost plus interest reinvested. Investment in any other
financial instrument is valued at market price.
Interest earned on investment are accrued and recognized as revenue in the account.
1.1.4 Accounts Receivable
Accounts receivable are carried at anticipated realizable value. However receivable accruing from
NHI levy is stated at full value per the collection reports issued by the Ghana Revenue Authority.
1.1.5 Foreign Currencies
Transactions in foreign currencies during the year are translated into Ghana cedis at prevailing rates
at the time of the transactions. Monetary assets and liabilities denominated in foreign currencies at
the balance sheet date are translated into Ghana cedis at the rates of exchange ruling on that date.
The differences resulting from the translation are dealt with in the income statement in the period in
which they arise.
1.1.6 Property, Plant & Equipment
Property, plant and equipment are stated at cost less accumulated depreciation. The cost of an asset
comprises its purchase price any direct attributable costs of bringing the assets to working condition
for its intended use.
Expenditure on its repairs and maintenance are charged to the income statement.
1.1.7 Depreciation
Property, plant and equipment are depreciated from the date of purchase on straight line basis at
fixed annual rates over the estimated useful life as follows;
Land & Buildings - 5%
Nationwide ICT Infrastructure - 25%
Computers & Accessories - 25%
Office Equipment - 20%
Plant & Machinery - 20%
Furniture & Fittings - 25%
Motor Vehicle - 20%
At the end of each reporting period, the Authority checks whether there is any indication that any
of its tangible assets have suffered an impairment loss. If there is indication of an impairment loss,
the recoverable amount of the asset is estimated to determine whether there has been a loss, if so,
its amount.
If there has been any impairment loss, the asset is written down to its recoverable amount, with the
loss charged to the statement of performance.
43 | P a g e
1.1.8 Expenditure
Expenditure on support to schemes and partner institutions are recognized when the Authority has
paid or has obligation to transfer funds to the schemes and other beneficiary institutions. Other
operating expenses are recognized when, and to the extent that, the goods and services have been
received.
1.1.9 Taxation
The Authority is not liable to corporation tax. Expenditure is shown inclusive of irrecoverable VAT.
The irrecoverable VAT is charged to the most appropriate expenditure heading or capitalized if it
relates to an asset.
NOTE 2 - NHIA LEVIES
GH¢’ million
2013
Dec 31
GH¢’ million
2012
Dec 31
Import VAT 400.05 364.95
Domestic VAT 250.15 208.41
650.20 573.36
NOTE 3 - SUPPORT TO MINISTRY OF HEALTH
GH¢’ million
2013
Dec 31
GH¢’ million
2012
Dec 31
Primary Health & Preventive Care 13.54 43.21
Health Service Investment 5.92 20.86
District Health Projects & Parliamentary M & E 12.22 10.60
31.68 74.67
NOTE 4 - ADMIN & LOGISTICAL SUPPORT TO DISTRICT OFFICES
The Authority has fully taken over the salary administration of the District Offices. As a result, the
District offices salary cost are added to NHIA operating expense
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NOTES 5 - NHIA GENERAL OPERATING EXPENDITURE
GH¢’ million
2013
Dec 31
GH¢’ million
2012
Dec 31
Authority Operating Expenses
Compensation 70.01 34.48
Other Allowances/Honorarium 0.35 0.41
Staff Training 2.59 1.52
Staff Welfare & Transfer Grant 0.50 0.43
Council Fees & Allowances 1.05 1.07
Allowances- Health Select Committee 0.90 0.79
Maintenance 0.85 0.47
Utilities 0.72 0.49
Printing, Publication & Stationery 0.87 0.94
Monitoring & Evaluation 0.36 0.45
Travelling Allowances & Expenses 1.26 1.08
Consultancy & Technical Assistance 1.33 0.53
Financial Charges 0.70 0.53
Exchange Difference (0.44) (0.50)
Legal & Professional Subscription & Services 0.05 0.09
Publicity, Communication & Adverts 0.99 0.79
Conferences & Meetings 1.16 0.85
NHIS @ 10 Anniversary 0.79 0.00
Tariff & Review of Drug List 0.19 1.04
Audit Fees 0.39 0.36
Rent & Insurance 0.87 0.37
Cleaning, postal & Security Services 0.53 0.20
45 | P a g e
Vehicle Running Cost 0.54 0.53
Sponsorship & Donation 0.13 0.07
Sundry Expenses 0.07 0.07
86.76 47.06
Other General Expenses
Data Centre Management & Maintenance 10.19 9.22
Archival Services 2.03 0.14
Call Centre expenses 1.92 3.19
Corporate Social Responsibility 0.52 0.59
14.66 13.14
Total 101.42 60.20
NOTES – 6 PROPERTIES, PLANT & EQUIPMENT
GH¢’million GH¢’million GH¢’million
Cost 1/1/2013 Additions 31/12/13
Nation-Wide ICT 34.08 0.00 34.08
Office Land & Buildings 18.94 0.50 19.44
Office Land & Buildings (WIP) 0.00 7.72 7.72
Office Equipment 0.87 0.06 0.93
Plant & Machinery 0.10 0.49 0.59
Computer & Accessories 3.39 0.10 3.49
Office Vehicles 1.60 0.92 2.52
Furniture & Fittings 2.12 0.45 2.57
Biometric Project 10.37 38.40 48.77
Total 120.11 46.43 166.54
Depreciation
Nation-Wide ICT 24.56 8.53 33.09
Office Land & Buildings 1.17 1.32 2.49
Office Equipment 0.57 0.14 0.71
Plant & Machinery 0.02 0.12 0.14
Computer & Accessories 1.73 0.77 2.50
Office Vehicles 0.96 0.35 1.31
Furniture & Fittings 1.63 0.53 2.16
Total 30.64 11.76 42.40
Net Book Value 40.83 77.71
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NOTES -7 INVESTMENTS
GH¢’ million
2013
Dec. 31
GH¢’ million
2012
Dec. 31
Access Bank 0.00 18.65
Agricultural Development Bank 3.45 5.64
Bank of Africa 0.00 19.52
CAL Merchant Bank 21.71 17.62
CDH Securities 2.00 2.00
Ecobank Ghana 0.00 9.85
Fidelity Bank 1.57 2.00
First Atlantic Merchant Bank 4.58 14.94
Merchant Bank 3.19 5.64
National Investment Bank 14.44 19.96
Prudential Bank 6.85 5.57
Unibank Ghana Limited 21.47 18.05
Unique Trust Bank 10.40 8.35
Zenith Bank 8.79 0.73
First Capital Plus 29.09 15.40
All-Time Capital Ltd 6.20 5.00
Stanbic Bank 5.70 0.00
FirstBanC Financial Services 5.00 0.00
TOTAL 144.44 168.92
NOTES -8 INTEREST INCOME RECEIVABLE
This is in respect of investment income earned but yet to be received on
different investments as at the close of December 2013.
47 | P a g e
NOTES -9 OTHER RECEIVABLES
GH¢’ million
2013
Dec. 31
GH¢’ million
2012
Dec. 31
Claims Prepayment - KATH 0.93
Rent & Insurance 0.00 0.19
Staff Loans 1.34 0.78
Sundry Receivables 0.13 0.14
1.47 2.04
NOTES- 10 BANK & CASH
GH¢’ million
2013
Dec. 31
GH¢’ million
2012
Dec. 31
BANKS
Bank of Ghana 0.09 -
Ghana Commercial Bank 21.19 8.92
Ecobank Ghana 1.95 0.88
Merchant Bank 0.01 0.05
Bank of Africa 0.46 0.46
HFC Bank 0.06 0.22
Stanbic Bank 0.00 5.23
Energy Bank 5.47 5.25
GCB (CPA) 0.80 1.72
ADB (CPA) 0.08 1.81
CAL Bank 0.04 0.03
30.15 24.57
CASH 0.17 0.02
Total 30.32 24.59
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NOTES -11 LOAN & INTEREST
This is represents the balance on the Loan taken by NHIA on behalf of government of Ghana for
the settlement of service providers claims. The initials loan was GH¢140.00 million, out of which a
balance of GH¢104.80 million and interest of GH¢7.69 million remain outstanding at the end of
December 2013.
NOTES- 12 ACCOUNTS PAYABLE
GH¢’ million
2013
Dec. 31
GH¢’ million
2012
Dec. 31
Ministry of Health- Primary Health Care 0.41 5.50
Ministry of Health – Health Service Investment 1.07 0.24
Parliamentarians – District Health Project 4.74 1.48
SSNIT Contribution 1.56 2.03
Ghana Revenue Authority 3.14 1.88
Provident Fund 0.40 1.20
Accrued Expenses & Others 11.80 4.81
23.12 17.14
NOTES- 13 ACCUMULATED FUND
GH¢’ million
2013
Dec. 31
GH¢’ million
2012
Dec. 31
Opening Balance 201.86 227.38
Excess Expenditure over Income (96.80) (25.52)
Salary Advance-District Offices 0.21 0.00
105.27 201.86
50 | P a g e
APPENDIX 3: QUANTITATIVE AND QUALITATIVE ASSESSMENT OF TARGETS FOR THE YEAR 2013
# Activity Target Achievement Remarks
1 Step up dialogue with Ministry of Finance in order to
access all receivable funds on timely basis
60% 78% The amount received
included arrears for 2012
received in 2013
2 Increase the sources of funding by one and increase the
NHIL by 1%
1 new funding
source and 1%
increase in NHIL
Not achieved Proposals have been
submitted to Government
for consideration.
3 Strengthen controls to minimize premium leakages by
setting up Consolidated Premium Account (CPA)
Operationalising
Consolidated
Premium Account
(CPA)
CPA operationalised
Creation of Consolidated
Premium Accounts yielded
positive results
4 Cut down on administrative and operational expenses Admin
expenditure not
more than 13% of
total expenditure
Admin expenditure
not more than 11% of
total expenditure
Cost containment measures
implemented to ensure
prudent financial
management
5 Introduce e-claims to improve claims processing turn-
around time
15% by end of
2013
Implemented in 47
facilities
To be extended to other
facilities in 2014
6 Solicit support from Development Partners (DPs) 4 DPs 6 DPs
2 additional DPs came on
board to support the NHIA
7 Review the NHIA Financial Manual By end of Q4 Completed
Awaiting training for all
Regional and District
Accountants
8 Implement Biometric Membership Registration 2 districts by end
of Q3
Piloted in Ayawaso
and La districts
To be roll-out nationwide
in 2014
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Quantitative and qualitative assessment of targets for the year 2013
# Activity Target Achievement Remarks
9 Set up enrollment targets for district offices By end of Q4 Regions supported
to set enrolment
targets for
Districts
Enrolment targets were set
for the regions, and this
practice will continue in
the ensuing years
10 Increase the active membership of poor and indigents
by 30% over baseline by end of 2013
1,000,000 1,123,106 poor
and indigents
registered
Special registration
exercises contributed to
the increased enrolment
11 Increase active membership to 38% by end of 2013 38% 38.3%
Special registration
exercises will be used as
means of increasing
enrolment
12 Enroll LEAP Beneficiaries unto the NHIS 10,700 930,000 LEAP
Beneficiaries
registered
Collaboration with Social
Welfare Department in
registering LEAP
Beneficiaries yielded
positive results.
13 Complete organizational reforms/restructuring to
reflect the new Act (Act 852)
Departments/Units
with similar functions
integrated and
harmonized by end of
Q2
Departments/Units
with similar
functions
integrated and
harmonized
Organisational
restructuring to continue in
2014
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Quantitative and qualitative assessment of targets for the year 2013
# Activity Target Achievement Remarks
14 Support Health Sector investments as recommended by
the MOH
60% 37% released Releases were based on
funds received from
Ministry of Finance
15 Revise the Benefit Package, Tariffs and Medicines
Prices
Aspects of family
planning services
included in the benefit
package, new tariffs
and medicines process
in use by end of Q3
New Tariffs and
Medicines Prices
in use.
Proposal for inclusion of
family planning services is
being discussed
16 Develop LI for the new Act (Act 852) By end of 2013 Pending
A Consultant is to be
engaged to support the
process
17 Review HR Manual and institutionalize job rotation at
all levels
By end of Q3 On-going Job rotation to begin in
2014
18 Mainstream M&E within the NHIA M&E Department
established by end of
2013
M&E Department
established
Awaiting upgrading into a
Directorate
19 Construct head office annex to accommodate CPC1
and reduce rental cost into the future
Construction to begin
by before end of 2013
Construction
works on-going
To be completed in 2014
20 Complete construction works on all regional office
buildings
By end of Q2 Completed All regional office
building commissioned
53 | P a g e
Quantitative and qualitative assessment of targets for the year 2013
# Activity Target Achievement Remarks
21 Increase responsiveness to subscriber issues by
improving communication between subscribers and the
scheme
Clearly defined
communication
strategy developed by
end of Q2
Communication
strategy developed
Dissemination of
communication
strategy is on-going
22 Compile and make available subscriber handbook that
contains basic information including the rights and
responsibilities for subscribers
Subscriber Handbook
produced and made
available by end of Q3
Subscriber
Handbook
developed
To be ready for
dissemination in Q1 of
2014
23 Establish additional Claims Processing Centres (CPCs)
3 CPCs established 2 CPCs established Increased efficiency in
claims processing
24 Re-construct NHIS website By Q3 NHIS website
upgraded to include
other social media
Twitter and Facebook
introduced into NHIS
website
25 Re-brand the NHIS in line with Act 852 By end of Q3 A new brand
developed, and a
new logo launched
Education on new
brand is on-going
26 Support Providers to improve quality of service through
credentialing and post-credentialing monitoring
100% of applications
inspected
15% of credentialed
facilities monitored
22% of applications
inspected.
Post-credentialing
monitoring tools
developed, awaiting
dissemination at
stakeholders meeting
All vetted applications
to be inspected and
credentialed in 2014
